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.
Qualifications of a Good Medical Coder
The first step to defining the qualifications you require from your medical coder is to make a list of what you expect him or her to do. In some practices, coders only code, and do not enter charges, bill claims, or follow up on claims. There are other practices in which the coder is responsible for
- data entry
- claim follow-up
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
- retrieving & reviewing medical records
- assigning the correct procedure and diagnosis codes
- reviewing documents coded by others
- creating reports
- submitting claims
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.
Why Finding Good Coders Is a Challenge Right Now
If it sounds like finding a great medical coder could be a challenge, that's because it is. Medical coders are in particularly high demand right now because of the recent transition to ICD-10 on October 1. ICD-10 has several times as many codes as did ICD-9, and the new codes are longer and packed with more information. Ultimately, ICD-10 will allow for better tracking of health data on both on a granular level and in terms of large populations, but the transition has been a huge challenge for most physician practices.
If you can find a medical coder with experience in both ICD-9 and ICD-10, you will be especially fortunate. Becoming a medical coder requires hard work and mastery of a broad range of academic and technical skills, so not just anyone can do it. Expect to have to search for good coders for at least the next year, while everyone is adjusting to ICD-10.
For a good overview of the coding profession and its importance in medicine, check out this infographic created by TopMedicalCodingSchools.com:
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.