Job Description

Summary:

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.

Responsibilities:

• Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
• 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.
• 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.
• 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.
• 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.
• 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.
• Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
• 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.

Education and Certification Requirements:

High School Diploma or Equivalent (Required) and Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC.

Required Work Experience: For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience

Job Tags

Similar Jobs