Medical Coder III
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What you'll do
- Review clinical notes, dialysis encounter logs, physician orders, diagnostic reports, and patient comorbidity documentation to extract relevant clinical data.
- Assign and sequence accurate ICD-10-CM, CPT, and HCPCS codes and appropriate billing modifiers according to official coding guidelines, CMS rules, and DaVita compliance standards.
- Validate, edit, and finalize automated coding recommendations generated through CWOW and Computer-Assisted Coding engines.
- Verify that patient diagnoses, dialysis prescriptions, and treatment details match billing requisitions.
- Investigate, correct, and appeal complex claim denials resulting from coding mismatches, bundling rules, medical necessity requirements, or payer-specific guidelines.
- Coordinate with Billing, Collections, and Clinical Documentation Integrity (CDI) teams to ensure root causes of recurring claim errors are addressed.
- Conduct documentation and coding audits in accordance with DaVita Clinical Medical Record Policies and Procedures (P&Ps) and state-mandated audit requirements.
- Ensure full adherence to HIPAA regulations and protect Protected Health Information (PHI) at all times.
- Act as a senior technical SME for Medical Coder I and II teammates, providing guidance on difficult coding scenarios and payer guidelines.
- Assist leadership in developing coding tip sheets, standard operating procedures, and training materials.
What they're looking for
- High School Diploma or equivalent required ; Associate or Bachelor’s degree in Health Information Management (HIM) or a related field preferred.
- Active medical coding certification required (e.g., CPC through AAPC, CCS / CCS-P / RHIT through AHIMA).
- 3–5+ years of progressive medical billing and coding experience (nephrology/dialysis, outpatient, or hospital coding experience preferred).
Nice to have
- Associate or Bachelor’s degree in Health Information Management (HIM) or a related field preferred.
- nephrology/dialysis, outpatient, or hospital coding experience preferred
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Posting Date
09/18/20262476 Swedesford RdSTE 150, Malvern, Pennsylvania, 19355-1456, United States of AmericaThe Health Information Management (HIM) Medical Coder III of the Coding/Audit team will support DaVita’s HIM Coding and Audit operations. This position assists in developing or revising procedures to achieve maximum efficiency with the coding and auditing processes, mentors new and/or existing staff to achieve maximum autonomy and professional knowledge, and provides problem resolution for internal and external partners.
Essential Duties & Responsibilities
Medical Record Review & Code Assignment
- Review clinical notes, dialysis encounter logs, physician orders, diagnostic reports, and patient comorbidity documentation to extract relevant clinical data .
- Assign and sequence accurate ICD-10-CM, CPT, and HCPCS codes and appropriate billing modifiers according to official coding guidelines, CMS rules, and DaVita compliance standards .
Computer-Assisted Coding (CAC) & Clinical Workflow (CWOW)
- Validate, edit, and finalize automated coding recommendations generated through CWOW and Computer-Assisted Coding engines .
- Verify that patient diagnoses, dialysis prescriptions, and treatment details match billing requisitions .
Complex Case Management & Denial Resolution
- Investigate, correct, and appeal complex claim denials resulting from coding mismatches, bundling rules, medical necessity requirements, or payer-specific guidelines .
- Coordinate with Billing, Collections, and Clinical Documentation Integrity (CDI) teams to ensure root causes of recurring claim errors are addressed .
Quality Assurance, Compliance & Documentation Auditing
- Conduct documentation and coding audits in accordance with DaVita Clinical Medical Record Policies and Procedures (P&Ps) and state-mandated audit requirements .
- Ensure full adherence to HIPAA regulations and protect Protected Health Information (PHI) at all times .
Mentorship & Subject Matter Expertise
- Act as a senior technical SME for Medical Coder I and II teammates, providing guidance on difficult coding scenarios and payer guidelines .
- Assist leadership in developing coding tip sheets, standard operating procedures, and training materials .
Qualifications & Requirements
- Education: High School Diploma or equivalent required ; Associate or Bachelor’s degree in Health Information Management (HIM) or a related field preferred.
- Certifications: Active medical coding certification required (e.g., CPC through AAPC, CCS / CCS-P / RHIT through AHIMA) .
- Experience: 3–5+ years of progressive medical billing and coding experience (nephrology/dialysis, outpatient, or hospital coding experience preferred) .
- Technical Skills:
- In-depth knowledge of ICD-10-CM, CPT/HCPCS, NCCI edits, and payer reimbursement rules .
- Proficiency in Electronic Health Record (EHR) systems (e.g., CWOW, Epic) and practice management tools .
- Working knowledge of Microsoft Office applications (Excel, Teams, Outlook, Word)
What We’ll Provide:
More than just pay, our DaVita Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings.
Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more
Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning.
#LI-TT1
At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
This position will be open for a minimum of three days.
The Wage Range for the role is $26.50 - $40.50 per hour.
For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates
Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits
Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.
Company
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