Coder II

The coding function ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement through documentation review as well as abstracting billable services from documentation to capture missed revenue. The employee reviews, analyzes, and codes diagnostic and procedural information as supported by documentation in accordance with Medicare, Medicaid, and private insurance guidelines. This position  is responsible for timely, accurate, and comprehensive review of services. The coder is responsible for identifying and reporting compliance concerns that would place the organization at risk for fraudulent billing and works with the coder supervisor to identify billing trends and educational opportunities.

ESSENTIAL JOB FUNCTIONS

• Abstracts, assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures as supported by documentation. Assures the final diagnoses and operative procedures as stated by the physician are valid and coded to the highest level of specificity. Abstracts all necessary information from documentation to identify secondary complications and co-morbid conditions.
• Meets FMG Production standards for coding procedures.
• Meets FMG Quality standards per the Coding Audit and Monitoring process.
• Follows all Coding department policies and procedures.
• Understands and applies changes in the external regulatory environment, third party reimbursement agencies, and stays current with coding updates ensuring clean claims are submitted for adjudication.
• Performs a comprehensive review of the documentation to assure the presence of all component parts such as: patient and record identification, signatures and dates where required and other necessary data.
• Analyses, trends, and identifies front end edits based on denied claims. Correct or compose appeal letters when appropriate. Works closely with the insurance follow-up department.
• Performs coding reviews based on customer billing disputes. Works closely with the customer service department providing recommended feedback information regarding the disputed claims.

Performs related duties as required.

Education/ Work Experience:

Two years of coding experience using CPT and ICD-10-CM or equivalency.  

Licensure/Certifications:

Certified Professional Coder Apprentice (CPC-A), (CPC) (AAPC) or Certified Coding Associate (CCA), (CCS, CCS-P) (AHIMA) required.   The incumbent is expected to enroll in continuing education courses to maintain certification.  

Job Knowledge and Skills:

Advanced knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record.

Advanced knowledge of medical codes involving selections of the most accurate and descriptive codes using the ICD-10-CM, Volumes 1- 3, CPT, and HCPCS.

Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-10-CM code.

Advanced knowledge of medical codes involving selection of the most accurate and descriptive code using the CPT codes for billing of third party resources.

Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.

Knowledge of Epic Electronic Health Record in order to analyze encounters and notify providers of data that needs corrections through Epic In basket.

Must have good math skills and effective communication skills.  Must be knowledgeable of FMG coding policies.  Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data.  Requires skill in the use of a wide variety of office equipment including: computer, calculator, facsimile, copy machine, and other office equipment as required. Must be able to follow instructions and work independently.  

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.