The Medical Coder is responsible for accurately assigning ICD‑10‑CM, CPT, and HCPCS codes to inpatient, swing bed, outpatient, emergency, and ancillary services in accordance with federal regulations, payer guidelines, and Critical Access Hospital billing requirements.
Ensure complete and compliant documentation, supports timely claims submission, and contributes directly to the hospital’s revenue integrity and quality reporting.
Review provider documentation and assign accurate codes for all CAH service lines.
Apply CAH‑specific billing rules, including Method I/II requirements if applicable.
Ensure coding aligns with CMS, OIG, NCCI, and payer‑specific guidelines.
Query providers when documentation is incomplete, unclear, or inconsistent.
Validate medical necessity and support accurate charge capture.
Maintain compliance with HIPAA, CMS Conditions of Participation, and CAH billing regulations.
Participate in internal and external coding audits.
Collaborate with billing, utilization review, and clinical departments to resolve coding‑related claim edits or denials.

High School graduate or equivalent.
Certification required: CPC, CCS, CCS‑P, RHIT, or RHIA.
Equivalency option: In lieu of certification, a minimum of 5 years of progressively responsible hospital coding experience is required, preferably in a Critical Access Hospital or multi ‑ service rural facility.
Strong knowledge of ICD‑10‑CM, CPT, HCPCS, and modifier usage.
Familiarity with CAH billing methodologies, UB‑04 claims, and Medicare guidelines.
Experience with rural health clinic (RHC) coding.
Knowledge of swing bed documentation and billing requirements.
Experience with EHR and encoder software (e.g., TruBridge, 3M, Optum).
Able to communicate effectively in English, both verbally and in writing.
Additional languages preferred.

Medical Coder

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