Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.
Requirements
- Enhances and maintains coding knowledge and skills
- Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes
- Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding
- Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments
- For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding
- Submits daily productivity report to HIM manager by defined deadline
- Meets and maintains HIM coding quality and productivity standards
- Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements
- May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures
- Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments
- Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity
- Researches medical record for any additional diagnoses documented to meet medical necessity
- Communicates with insurance companies about coding errors and disputes (physician billing)
- Abstracts pertinent data points for billing and quality reviews
- Communicates with various departments as needed to ensure accuracy of patient data
- Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes
- Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing)
- For physician billing, collaborates with billing department to ensure all bills are satisfied
- For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing
- Makes appropriate coding corrections, when advised, and follows procedure to notify billing
Benefits
- Health insurance
- Retirement plan
- Paid time off
