The Coder will be responsible for reviewing all medical record information to select diagnoses and procedures. In accordance with ICD 10 CM/PCS, CPT, E/M, HCPCS and modifiers and coding guidelines, the coding specialist will assign appropriate codes and DRGs/APC for statistical and reimbursement purposes. Assigning codes utilizing an electronic encoder application in accordance with the practice policy and regulatory guidelines. Strong knowledge of medical terminology, anatomy & physiology, and pharmacology is needed.
Position Reports To: Business Office Manager
- Reviews electronic coding workqueues for charges presented for proper use of diagnosis and procedure codes.
- Receives paper charge tickets and appropriately prepares for charge entry.
- Confirms accurate patient demographics on each ticket including MSN #, patient #, insurance information, etc. according to department policy.
- Verifies service provider and billing provider number fields are populated.
- Verifies referring provider number field is populated, if appropriate.
- Applies knowledge of coding rules, verifies the proper use of the following items, and makes appropriate corrections:
- Payor specific billing guidelines
- ICD-10 diagnosis codes
- Multiple surgery guidelines
- CPT4 E&M and procedure codes
- DMERC guidelines
- HCPCS codes
- Rural Health guidelines
- CCI edits
- Effectively uses software and/or coding books to verify coding accuracy.
- Reviews charge sessions for proper coding for special departments (e.g., Charity care, special accounts, MVA, L&I, etc.) and transfers session to the appropriate specialist for completion.
- Responsible to stay current with billing guidelines and reimbursement rules and regulations.
- Provides feedback to providers regarding incorrect coding using authorized methods as dictated by department policy.
- Works with clinical staff to resolve coding issues and related problems.
- Participates in educational activities as requested (i.e., attending meetings with clinical staff).
- Completes production logs as required for department statistical reporting.
- May be requested to perform job tasks not specifically related to primary assignments for the success of the organization as requested by management.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
- High School graduate or equivalent.
- American Academy of Professional Coders certification [AAPC].
- Proficient in the performance of basic math functions.
- Possesses basic computer (e.g., spreadsheets, word processing) skills.
- Must be a team player.
- Maintains a positive, resourceful attitude toward achieving overall department and clinic goals.
- Knowledge of ICD-10, CPT coding, medical terminology, and insurance billing.
O = Occasional, represents 1 to 25% or up to 30 minutes in a 2 hour workday.
F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour workday.
C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.
Physical/Sensory Demands For This Position:
- Walking - F
- Sitting/Standing - C
- Reaching: Shoulder Height - F
- Reaching: Above shoulder height - F
- Reaching: Below shoulder height - F
- Climbing - O
- Pulling/Pushing: 25 pounds or less - O
- Pulling/Pushing: 25 pounds to 50 pounds - O
- Pulling/Pushing: Over 50 pounds - O
- Lifting: 25 pounds or less - O
- Lifting: 25 pounds to 50 pounds - O
- Lifting: Over 50 pounds - O
- Carrying: 25 pounds or less - O
- Carrying: 25 pounds to 50 pounds - O
- Carrying: Over 50 pounds - O
- Crawling/Kneeling - O
- Bending/Stooping/Crouching - F
- Twisting/Turning - F
- Repetitive Movement - F
Normal office environment.
Physical Exposures For This Position:
- Unprotected Heights - No
- Heat - No
- Cold - No
- Mechanical Hazards - No
- Hazardous Substances - No
- Blood Borne Pathogens Exposure Potential - No
- Lighting - No
- Noise - No
- Ionizing/Non-Ionizing Radiation - No
- Infectious Diseases - No