Under general supervision, reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes office and hospital procedures for providers to ensure proper reimbursement. Provides education to the providers to ensure proper documentation and assignment of ICD-10-CDM, HCPCS and CPT codes. Reports to the Coding Operations Supervisor.
Essential Job Functions:
- Audits records to ensure proper submission of services prior to billing on pre-determined selected charges.
- Receives hospital information to properly bill provider services for hospital patients.
- Supplies correct ICD-10-CM diagnosis codes on all diagnoses provided.
- Supplies correct HCPCS code on all procedures and services performed.
- Supplies correct CPT code on all procedures and services performed.
- Contacts providers to train and update them with correct coding information.
- Attends seminars and in-services as required to remain current on coding issues.
- Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory bodies.
- Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
- Maintains all mandatory in-services.
- Maintains compliance standards in accordance with the Compliance policies. Reports compliance problems appropriately.
- Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
- Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
- Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
- Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
- Reviews department edits in billing software and make any corrections based on supported documentation and medical necessary.
- Performs other related duties, which may be inclusive, but not listed in the job description.
- High School Diploma
- Medical Coding Certificate – CBCS (Certified Billing and Coding Specialist), CCS (Certified Coding Specialist) or CPC (Certified Professional Coder) certification is required.
- Excellent interpersonal skills.
- One year coding experience using ICD-10-CM, CPT, HCPCs or equivalency.
- Experience with Cardiology coding preferred.
- Computer competency.
- Good math and effective communication skills.
- Knowledge of medical records and EHR required.
- Knowledge of Federal laws and regulations affecting coding requirements.
- Knowledge of principles, practices and methods of current coding.
- Knowledge of office practices, etc.
- Knowledge of billing practices.
- Knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services
- (CMS) for assignment of diagnostic and procedural codes.
Must be able to sit for long periods of time, and must have manual dexterity to work computer systems and keyboard. It is reasonable to anticipate lifting 10 -15 pounds in any given day