Medical Coder

Job Description

Job DescriptionBenefits:

• 401(k)
• 401(k) matching
• Company parties
• Dental insurance
• Health insurance
• Opportunity for advancement
• Paid time off
• Training & development
• Vision insurance

Position Overview


The ICD-10 Home Health & Hospice Medical Coder is responsible for accurately reviewing, analyzing, and assigning ICD-10-CM diagnosis codes to clinical documentation for home health and hospice services. This role ensures compliance with CMS guidelines, OASIS requirements, and agency policies to support precise reimbursement, high-quality patient care, and regulatory compliance.
The ideal candidate has demonstrated experience in Home Health ICD-10 coding, strong knowledge of OASIS/Evaluation criteria, and a thorough understanding of PDGM (Patient-Driven Groupings Model).

Key Responsibilities
Coding & Documentation Review

• Review clinical documentation to identify appropriate and accurate ICD-10-CM codes for home health and hospice encounters.
• Assign primary and secondary diagnoses following CMS, PDGM, and regulatory requirements.
• Validate medical necessity and ensure coding supports the plan of care and services rendered.
• Review and interpret physician orders, clinical notes, OASIS assessments, and other documentation to ensure accurate code selection.

Quality, Compliance & Auditing

• Ensure all coding aligns with CMS, industry, and agency standards, including PDGM/PEPPER guidelines.
• Conduct self-audits or participate in agency coding audits to maintain accuracy and compliance.
• Assist with corrections and updates based on audit findings or regulatory changes.
• Maintain strict confidentiality and follow HIPAA requirements.

Collaboration & Communication

• Communicate with clinicians, QA staff, and the billing department to clarify diagnoses, resolve documentation discrepancies, and improve coding accuracy.
• Provide feedback to clinical staff regarding documentation gaps that impact coding or reimbursement.
• Participate in training or educational sessions to enhance coding competency and knowledge of industry updates.

Data Integrity & Workflow Management

• Complete coding assignments within established departmental timelines.
• Ensure accurate and timely submission of coded encounters for billing and compliance.
• Assist in optimizing coding workflows, documentation processes, and clinical data accuracy.

Required Qualifications

• Minimum 2 years of Home Health ICD-10 coding experience (required).
• Certification from a recognized credentialing body such as:
  
  • HCS-D (Home Care Coding SpecialistDiagnosis) preferred
• • CPC, CCS, COC, or RHIT/RHIA accepted with Home Health-specific experience
• Strong understanding of PDGM, OASIS documentation requirements, and Medicare regulations.
• Experience with home health EMR systems (e.g., Homecare Homebase, WellSky/Kinnser, MatrixCare).
• Excellent analytical, critical-thinking, and documentation review skills.
• Strong understanding of pathophysiology, medical terminology, and clinical documentation requirements.

Preferred Qualifications

• Hospice coding experience (ICD-10-CM) strongly preferred.
• Knowledge of HIS (Hospice Item Set) and hospice regulatory requirements.
• Experience working remotely or in a high-volume coding environment.
• Familiarity with PEPPER reports and quality metrics for home health agencies.