Job Title: SNF Medical Coder
Job Summary:
We are seeking an experienced and detail-oriented SNF Medical Coder to ensure accurate and compliant medical coding for skilled nursing facility (SNF) services. This role involves reviewing clinical documentation, assigning correct ICD-10-CM, CPT, and HCPCS codes, and ensuring compliance with Medicare, Medicaid, and other payer guidelines. The coder will work closely with healthcare providers, billing teams, and compliance officers to optimize reimbursement and reduce denials.
Key Responsibilities:
- Review and analyze medical records to assign accurate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, and treatments in an SNF setting.
- Ensure compliance with federal, state, and payer regulations, including PDPM (Patient-Driven Payment Model) and MDS (Minimum Data Set) coding guidelines.
- Validate documentation to support proper code assignment and reimbursement under Medicare Part A and Part B for SNF services.
- Collaborate with healthcare providers to clarify documentation, resolve coding discrepancies, and optimize coding accuracy.
- Audit coding practices to identify trends, errors, and opportunities for improvement, reducing claim denials and rejections.
- Stay up to date with CMS guidelines, SNF-specific billing regulations, and changes in medical coding practices.
- Support billing and reimbursement teams by providing accurate coding information and resolving claim issues.
Qualifications:
- Certification Required: CPC (Certified Professional Coder), CRC (Certified Risk Adjustment Coder), or equivalent.
- Experience: Minimum 1-3 years of coding experience in SNF.
- Knowledge of SNF Coding: Familiarity with PDPM, MDS assessment coding, Medicare RUG-IV (if applicable), ICD-10-CM guidelines, and HIPPS codes.
- Technical Skills: Proficiency coding software, and Microsoft Office.
- Understanding of SNF Regulations: Knowledge of Medicare Part A and Part B billing, payer policies, and compliance requirements.
- Analytical & Detail-Oriented: Ability to identify coding inconsistencies and ensure high coding accuracy.
- Communication Skills: Ability to effectively communicate with physicians, nurses, and billing teams to resolve documentation issues.
Preferred Skills:
- Knowledge of HCC coding and risk adjustment methodologies.
- Experience with claim audits, denials, and appeals.
- Prior experience working with MDS coordinators and compliance officers.