SCOPE/GENERAL PURPOSE OF JOB:
The Coding Specialist is responsible for abstracting all E/M, CPT, HCPCS, ICD-10-CM, modifier, units from the medical record documentation. Other responsibilities include accurately entering data into coding/billing software and/or Excel reports. Performing accurate coding using applicable guidelines and facility protocols and communicating with staff and/or providers as needed. Provide written feedback of coding results as needed in the form of comments, summary of findings and recommendations. Ensure compliance with federal and state laws, regulations and standards related to health information and coding principles. Communicate with your direct manager as needed (i.e. schedule changes, daily assignments/work volume, coding questions, etc.)
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Assign ICD-10 CM and CPT codes with modifiers for services provided in the facility environment (Ancillary, ED, Evaluation and Management, Observations, Outpatient surgeries, and/or Professional fee coding) depending on the specific client assignment
- Review the medical record and all applicable documentation to determine the appropriate codes to assign for the services and diagnoses.
- Ensures diagnosis codes meet local and national medical necessity guidelines.
- Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all assigned services.
- Follow all HIPAA regulations and uphold a higher standard around privacy requirements.
- Demonstrates the technical competency to use the facility encoder as it interfaces with the hospital/physician mainframe and/ or EMR in remote setting.
- Demonstrates proficiency with Microsoft Office Applications in using required computer systems with minimal assistance.
- Review and resolves coding edits and denials. Assists with rebilling accounts when necessary.
- Maintain a working knowledge of various laws, regulations and industry guidance that impact compliant coding.
- Must meet all coder productivity and quality goals.
- Maintain a 95% accuracy rate.
- Other duties as assigned.
EDUCATION AND/OR EXPERIENCE:
- High School Diploma or GED required.
- Associates or bachelor’s in health information preferred, but not required.
- Business experience preferred, but not required.
- Must be a certified coder through AAPC or AHIMA (CPC, COC, CCS, CCS-P, RHIT, RHIA)
- Three to five years of outpatient coding experience.
- Knowledge of ICD, CPT, HCPCS, Anatomy, Physiology, Medical Necessity, Modifiers, and Denials.
- Excellent writing and interpersonal sills
- Ability to work independently.
- Knowledge Areas:
- Organizational policies and procedures.
- Health care administration and business principles.
- Clinical processes and procedures as they relate to healthcare coding.
- Health insurance policies and procedures, particularly as they relate to claims processing.
- Apply knowledge of anatomy, clinical disease process and medical terminology to ensure accurate procedure, supply and diagnosis code assignment.
- Ability to communicate effectively and professionally with coding staff, clinical staff and administrative staff.
- Ability to communicate effectively in oral and written form.
- Ability to establish and maintain effective professional working relationships with all employees and clients.
- Requires analytical, organizing, planning and problem-solving abilities
- Exercises initiative, judgment, discretion and decision-making to achieve business unit objectives.
- Identifies problems and suggests resolution.
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.