Major Responsibilities:
- Reviews medical documentation at a proficient level from clinicians, qualified health professionals, and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations using EMR and/or Computer Assisted Coding software.
- Adheres to the organization and departmental guidelines, policies, and protocols.
- Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
- Conducts independent research to promote knowledge of coding guidelines, regulatory policies, and trends.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
- Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
- Meets and exceeds departmental quality and productivity standards.
- Recommends modifications to current policies and procedures as needed to coincide with government regulations.
- Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable.
Licensure, Registration, and/or Certification Required:
- Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).
Education Required:
- Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge).
Experience Required:
- Typically requires 3 years of experience in professional coding that includes experiences in either hospital or professional revenue cycle processes and health information workflows.
Knowledge, Skills & Abilities Required:
- Advanced knowledge of ICD, CPT, and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy, and physiology.
- Intermediate computer skills including the use of Microsoft Office products, electronic mail, including exposure or experience with electronic coding systems or applications.
- Advanced communication (oral and written) and interpersonal skills.
- Advanced organization, prioritization, and reading comprehension skills.
- Advanced analytical skills, with a high attention to detail.
- Ability to work independently and exercise independent judgment and decision-making.
- Ability to meet deadlines while working in a fast-paced environment.
- Ability to take initiative and work collaboratively with others.
Physical Requirements and Working Conditions:
- Exposed to a normal office environment.
- Must be able to sit for extended periods of time.
- Must be able to continuously concentrate.
- Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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