Data Quality Senior Medical Coder - Remote

A Day in the Life 

• The Data Quality (DQ) Senior Coder performs medical record coding and abstracting reviews with expert knowledge of ICD-10-CM, ICD-10-PCS and CPT-4 classification systems. The DQ Senior Coder also completes appeals processing tasks for both the inpatient and outpatient Data Quality Appeal Teams. In all responsibilities, adheres to the Official Guidelines for Coding and Reporting, AHIMA Code of Ethics “Standards of Ethical Coding”, AHA Coding Clinic and technical rules outlined by hospital guidelines.

• Supports the mission statement of Munson Medical Center (MMC): Munson Medical Center is the core of a regional health system. In partnership with physicians, we provide quality, compassionate, comprehensive and cost-effective services for improvement of the health of our patients and the communities we serve.

• Embraces and support the Continuous Quality Improvement (CQI) philosophy of Munson Medical Center: We are committed to the name “Munson” meaning excellence. We will provide services that meet our customers’ requirements every time.

• Reviews and abstracts information from auditor denials to communication sheets. Forwards relevant documentation to nurses for appeal consideration or analysts for further review or action for coding errors.

• Processes appeals sent in the C360 system in an accurate and timely manner. Files appeals and maintains organized records for tracking and compliance. Writes E/M appeals to support accurate reimbursement. Logs and processes lost/won appeals to ensure proper follow-up and resolution.

• Reviews and responds to coding denial QUICs for both inpatient and outpatient teams. Escalates as needed to analysts for additional review/code correction. Collaborates intra and interdepartmentally to resolve discrepancies and ensure proper coding.

• Assists with outpatient coding reviews as needed to ensure accuracy and compliance with guidelines. Works closely with nurses, analysts, and DQ team members to process denials and appeals and resolves issues. Ability to accurately code and abstract medical records using ICD-10-CM diagnosis, ICD-10-PCS, and CPT-4 procedure codes. Meets productivity standards as defined by the department.

• Participates in ongoing education and training to maintain coding certifications and stays current with industry changes. 

• Assists with special projects, audits, and other tasks assigned by leadership.