Whether in a hospital, a physician practice, or a skilled nursing facility, medical coders are the essential connection between the clinicians who care for patients and the insurance companies that reimburse physicians under patient policies. The job of the medical coder is to inform insurers about patient diagnoses and treatments in a format that allows them to calculate reimbursements for medical services.
The Importance of a Medical Coder
A medical coder is able to extract information from a care provider's documentation and assign the correct diagnosis and procedure codes to it. They may deal with doctors' notes, lab test orders, medical imaging studies, and prescription requests to generate the appropriate codes. Without the right codes, insurers will either reject a claim, or will pay an incorrect amount. Coders are also responsible for re-filing rejected claims and handling records in the event of an audit. The right medical coder improves your facility's bottom line and may also protect you from liability surrounding insurance claims.
Most practices hire coders who are credentialed as Certified Professional Coders (CPC). While there are outstanding coders without certification, you can be confident that someone who has earned the CPC credential has mastered a number of relevant skills and techniques to add value to your medical practice.
Physicians who run specialty clinics may seek coders who have earned not only CPC status, but also certifications particular to the specialty. For example, a rheumatology clinic may look for a coder with specialty certification in rheumatology coding, cardiologists would look for a coder with a certification in cardiology coding, and so on.
Other Qualities to Look for in a Medical Coder
Finding a coder that can multi-task is very important. Over the course of a day, a medical coder can be responsible for a number of things including
Coders who have experience working with different insurers are generally preferable, as are coders with experience in filing both paper and electronic claims.
Facilities will also look for coders with experience using their particular electronic health record (EHR) software, and they generally want someone with excellent organizational skills, good communications skills, an eagerness to learn, and an affinity for a fast-paced work environment.
Finally, character is essential. Coders handle confidential medical information and are responsible for thousands of dollars in insurance reimbursement every day. So of course, checking references and backgrounds is considered due diligence when hiring medical coders.
Source: TopMedicalCodingSchools.comGroupOne Health Source is an industry leader in revenue cycle management services. Our Certified Professional Coders can help you prevent denials and maximize reimbursements. Contact us today to learn how our 20+ years of medical coding and billing experience can help you transform your revenue cycle.