US-Coding Assoc III

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.  

As our Professional Coder III you will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance). Every day you will accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for coding and reporting, reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner, and Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns. 

To thrive in this role, you must be Able to accurately abstract information from the medial records into the abstract system, according to established guidelines. 

Here’s what you will experience working as a Professional Coder III: 

• Assigns codes for diagnoses, treatments and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers. 

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines. 

• Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards 

• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity. 

• Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units) 

Required Skills: 

• High School Diploma or GED required CCS-P, CPC 

• Must be able to demonstrate proficiency in professional services (95% accuracy). 

• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (ie:  Documentation Guidelines ’95 & ’97)