Medical Coder
The Medical Coder reviews clinical documentation and assigns accurate International Classification of Diseases, Tenth Revision (ICD 10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Code on Dental Procedures and Nomenclature (CDT), and modifier codes for medical, dental, behavioral health, pharmacy, Purchased/Referred Care (PRC), and ancillary services. This role supports compliant billing, reimbursement optimization, and documentation accuracy across Kahtnuht’ana Development Corporation (KDC) operations, including all awarded proposals, Indian Health Service (IHS) contracts, and Tribal health system requirements.
PRINCIPAL ACTIVITIES & RESPONSIBILITIES
- Review documentation and assign accurate codes across all service lines.
- Ensure compliance with Medicare, Medicaid, commercial payer, Indian Health Service (IHS), and Tribal billing requirements.
- Identify documentation gaps and communicate with providers for clarification.
- Support charge entry, claim readiness, and reimbursement workflows.
- Assist with denial management and coding related corrections.
- Monitor coding updates and regulatory changes.
- Participate in internal audits and compliance reviews.
- Support training and documentation improvement initiatives.
- Maintain productivity and accuracy standards.
- Collaborate with clinical, billing, and operational teams to improve workflows.
- Validate documentation for medical necessity and alignment with payer policies, including IHS and Tribal program requirements.
- Ensure coding accuracy for Prospective Payment System (PPS), All Inclusive Rate (AIR), and wrap around reimbursement submissions.
- Assist in maintaining charge master accuracy and alignment with fee schedules and EHR configuration.
- Support coding quality improvement efforts tied to federal contract deliverables, grants, and proposal requirements.
- Travel up to 40%.