Coder I
Position Summary
A Coder I performs coding audits for quality checks and provider education.
Major Duties and Responsibilities
- Maintains working knowledge of coding and compliance.
- Provides coding training and support to all TPMG locations.
- Participates in coding-related denial meetings.
- Performs coding and auditing of medical record documentation to ensure accurate coding.
- Reviews and submits documentation for all Recovery Audit Contractors (RAC) requests; timely follow-up of RAC audit.
- Reviews and submits documentation for all Error Rate Testing (CERT) requests with timely follow up of CERT response.
- Reviews and submits documentation for Targeted Probe and Educate (TPE) requests.
- Reviews and submits documentation for medical record requests for all insurance carriers.
- Follows HIPPA guidelines.
- Works with providers and clinical staff to improve documentation.
- Works with the Central Billing Office team to ensure appropriate reimbursement.
- Reviews denied claims and retractions and makes appropriate corrections or advise if denial/retraction is warranted.
- Provides assistance with submitting appeals for denials/retractions.
- Works closely with Coding and Compliance Auditors and SWAT Team.
- Other duties as assigned.