What does a Medical Coder do?

The medical coder is responsible for ensuring that all requests for diagnostics and blood work issued a doctor use standard medical coding that is recognized health insurance providers as part of the medical coding process. The same set of codes is used to encode any claims that are generated and submitted to the health insurance provider, in addition to appearing on requests for testing that are authorized doctors. The medical coder’s job is to make sure that the right codes are used, that the right testing is done, and that the insurance company can review and process claims quickly and efficiently.

Health information coders are frequently employed as members of a doctor’s office staff. The office manager or the assistant who interacts with the various labs and medical testing facilities that the doctor chooses to use may be trained in the use of the codes, or this may be a responsibility delegated to the assistant. Because the codes are universal, this is usually not a difficult process to implement, though it does necessitate a talent for meticulous attention to detail. Failure to apply the correct medical code to the requested testing can result in a delay in accurately diagnosing the patient’s condition, as well as the insurance company rejecting the medical claim.

A medical coder who has completed training can also work for a lab, where he or she can review testing requests and ensure that everything is in order before the tests are performed. In this role, the medical coder will frequently collaborate with their counterparts in doctor’s offices, double-checking with the doctor if something about the paperwork does not appear to be in order. This can help to avoid payment delays to the lab, so the time spent reviewing is often well worth it.

Before the paperwork is submitted for further review, medical record coders at the insurance company will check to see if the codes attached to claims are valid codes. This is significant because most insurance companies use the same set of medical codes internally or have a cross-reference chart that links internal codes to externally used medical codes. When a coding specialist finds an invalid code, the claim review is immediately halted, and the claim is returned to the original submitter.

Working for health insurance providers, coders/abstractors are responsible for ensuring that resources are not spent on a claim that will not be paid if the procedure cannot be verified as covered under the terms of the insured party’s policy. The medical coder is an important position at several key stages in the process of providing health care administration because it ensures that the proper codes are used in the right context.