Medical Coder Job at Start Corporation in Houma

Job Description: We are looking for an experienced Medical Coder to join our team.

Minimum Requirements: High school diploma or equivalent required. Minimum 2-3 years of professional medical coding experience preferred. Completion of an accredited medical coding or medical billing and coding program preferred. Demonstrated knowledge of ICD-10-CM, CPT, HCPCS, E/M coding, Medicare and Medicaid coding requirements, and medical necessity. Knowledge of medical terminology, anatomy, and healthcare documentation. Experience with electronic health records and healthcare billing systems preferred. Experience reviewing provider documentation and resolving coding discrepancies.

Core Competencies: Ability to interpret payer policies, coding guidelines, and regulatory requirements. Strong analytical skills and attention to detail. Ability to communicate effectively with providers and administrative staff. Strong attention to detail and accuracy. Ability to maintain confidentiality and handle protected health information appropriately. Ability to work independently and meet established productivity and accuracy expectations. Job Duties / Skills Required Coding and Documentation ReviewReview medical records and assign appropriate ICD-10-CM, CPT, and HCPCS codes based on documentation and services provided. Review and validate E/M coding and appropriate levels of service. Ensure coding accurately reflects diagnoses, conditions addressed, procedures performed, and services documented. Identify incomplete, conflicting, or insufficient documentation and communicate with providers when clarification is necessary. Review documentation for medical necessity and appropriate linkage between diagnoses and services. Apply current CMS, Louisiana Medicaid, NCCI, and payer-specific coding guidelines. Maintain knowledge of annual and interim coding and regulatory updates. FQHC/RHC Coding and Billing Apply FQHC-specific billing and coding requirements, including qualifying visits, encounter coding, and applicable HCPCS codes. Understand the relationship between professional coding and FQHC Prospective Payment System (PPS) reimbursement. Review claims for appropriate FQHC billing methodology and payer-specific requirements. Understand differences among Medicare, Louisiana Medicaid, Medicaid Managed Care, and commercial payer requirements. Identify services that are separately billable, bundled, incidental, or included within the FQHC encounter payment. Maintain familiarity with coding requirements for primary care, preventive care, behavioral health, psychiatry, substance use disorder treatment, and other services provided by START Corporation. Claims Review and Denial Prevention Perform pre-bill and post-bill coding reviews as assigned. Review coding-related claim edits, denials, and rejections and recommend appropriate corrections. Assist Revenue Cycle staff with coding-related appeals, reconsiderations, and payer disputes. Identify recurring coding, documentation, or payer issues affecting reimbursement. Assist with root-cause analysis of coding-related denials and underpayments. Identify opportunities to improve clean-claim rates and reduce avoidable denials. Collaborate with Billing, Revenue Cycle, HIM, Compliance, clinical leadership, and providers to resolve coding issues. Provider Education and Compliance Provide coding and documentation guidance to physicians, nurse practitioners, physician assistants, behavioral health professionals, and other clinical staff. Educate providers regarding documentation requirements necessary to support billed services. Communicate coding concerns professionally and provide supporting regulatory or coding guidance. Assist with internal coding audits and corrective-action initiatives. Participate in provider education regarding CPT, ICD-10-CM, HCPCS, CMS, Louisiana Medicaid, and payer changes. Identify potential compliance concerns and appropriately elevate findings. Maintain documentation supporting coding decisions and audit findings. Quality and Value-Based Care Support Assist with accurate diagnosis coding related to risk adjustment and value-based care initiatives. Review documentation for appropriate capture of chronic conditions addressed during encounters. Support coding accuracy related to quality measures and preventive services. Collaborate with clinical and quality teams to improve documentation and coding accuracy while ensuring all reported diagnoses and services are supported by the medical record.

Benefits include: Medical, dental, and vision insurance; disability and life insurance; paid time off; 13 paid holidays per year for regular full-time employees; and a 403(b) retirement plan with employer matching.