Medical Group Coder II Job at Mohawk Valley Health Systems in Utica

Job Summary: Under the direct supervision of the Assistant Director of Revenue Cycle Management or Coding Supervisor, the Medical Group Coder will improve documentation, data quality and revenue cycle operations. The coder reviews and analyzes medical records to accurately select all forms of HCPCS service codes (HCPCS, CPT, CPTII, CPTIII) and ICD-10-CM codes for professional services of hospital-based surgical specialty providers. This includes services in the office or other outpatient settings and inpatient settings. Core Job Responsibilities Assign the applicable HCPCS (HCPCS, CPT, CPTII, CPTIII) service codes based on review and analysis of medical records, following CMS, CPT, insurance company, hospital based and office based guidelines. Assign applicable modifiers, review medical necessity, CCI and other internal and external coding edits. Assign applicable ICD-10-CM diagnosis codes based on knowledge of ICD-10-CM, insurance company, hospital based and office based guidelines. Submit queries to providers, clinical staff and managers regarding incomplete, unclear, or inconsistent documentation. Re-submit queries as necessary to ensure timely resolution. Provide education to providers and clinical staff regarding documentation and work flow opportunities. Assist departments with diagnostic and procedural coding. Assist Business Office with insurance denials. Perform other duties as required. Education/Experience Requirements