Medical Coder RemoteHybrid

Job Summary:

The Medical Coder is responsible for accurately assigning ICD10CM CPT and HCPCS codes to inpatient swing bed outpatient emergency and ancillary services in accordance with federal regulations payer guidelines and Critical Access Hospital billing requirements. This role ensures complete and compliant documentation supports timely claims submission and contributes directly to the hospitals revenue integrity and quality reporting.

Essential Duties & Responsibilities

Coding & Documentation

Review provider documentation and assign accurate ICD10CM CPT and HCPCS codes for all CAH service lines including inpatient swing bed ED outpatient clinics and ancillary departments.

Apply CAHspecific billing rules including Method I/II requirements if applicable.

Ensure coding aligns with CMS OIG NCCI and payerspecific guidelines.

Query providers when documentation is incomplete unclear or inconsistent.

Validate medical necessity and support accurate charge capture.

Compliance & Quality

Maintain compliance with HIPAA CMS Conditions of Participation and CAH billing regulations.

Participate in internal and external coding audits.

Assist in developing provider education based on audit findings and documentation trends.

Revenue Cycle Support

Collaborate with billing utilization review and clinical departments to resolve codingrelated claim edits or denials.

Monitor codingrelated claim rejections and implement corrective actions.

Support timely monthend close by ensuring all encounters are coded within established time frames.

Operational Responsibilities

Maintain productivity and accuracy benchmarks.

Stay current with coding updates regulatory changes and CAHspecific reimbursement rules.

Participate in staff meetings training and performance improvement initiatives.

Regulatory Requirements:

• High School graduate or equivalent.
• Certification required: CPC CCS CCSP RHIT or RHIA.
• Equivalency option:In lieu of certification a minimum of 5 years of progressively responsible hospital coding experience is required preferably in a Critical Access Hospital or multiservice rural facility.
• Strong knowledge of ICD10CM CPT HCPCS and modifier usage.
• Familiarity with CAH billing methodologies UB04 claims and Medicare guidelines.

• Experience with rural health clinic (RHC) coding.
• Knowledge of swing bed documentation and billing requirements.
• Experience with EHR and encoder software (e.g. TruBridge 3M Optum).

Language Skills:

• Able to communicate effectively in English both verbally and in writing.
• Additional languages preferred.

Skills:

• Basic computer knowledge.