Coder I Specialist
Department: Billing Office Postulate
Reports To: Director of Coding and Compliance, Coding Supervisor
FLSA Status: Non-Exempt
Revision Date: September 2016
Under general supervision, reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes emergency, urgent care and outpatient hospital procedures for providers and facilities to ensure proper reimbursement. Identifies and reports correct code selection from physician documentation, to included, but not limited to; chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported, as needed. Provides education to the providers to ensure proper completion of Electronic Health Records and proper assignment of ICD-9-CDM and ICD-10-CDM, HCPCS and CPT codes.
Essential Duties & Responsibilities
• Audit records to ensure proper submission of services prior to billing on pre-determined selected charges
• Receives clinical information to properly bill provider services for emergency, urgent, and outpatient hospital services.
• 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 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 and the Code of Conduct. 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
• Performs other related duties, which may be inclusive, but not listed in the job description.
• Promote patient loyalty and retention through quality Customer Service and quick resolutions.
• Ensure delivery of excellent customer service through communication, and coordinating with other departments to resolve issues.
• Complies with all applicable policies and procedures to meet JCAHO and company standards.
• Perform other duties as assigned
• Demonstrate knowledge of and adhere to regulations and Emergency Center policies and procedures pertaining to safety, emergency preparedness, infection control, OSHA, fire safety and hazardous materials
• Participate in performance improvement activities as necessary
• Maintain confidentiality of patient related issues and adhering to all HIPAA rules and regulations.
• Demonstrate effective interpersonal skills
• Treat all patients, visitors, and staff members fairly and with respect
• Utilize effective communication methods and skills
• Explain all procedures, treatments, and care while remaining aware of language barriers
• Able to perform care in non-judgmental manner and recognize discrepancies between patient and personal beliefs
Emergency Center Policy
• Ensure personal appearance is business casual and professional at all times
• Responsible for wearing Emergency Center identification badge at all times which must be visible and above the waistline
• Attend all required meetings and in-service education
• Remain flexible in staffing patterns and resolution of staffing conflicts; participates in temporary assignments
• Compliance with attendance standards
• Demonstrate flexibility when changes in assignments are necessary
EDUCATION & EXPERIENCE
• High School diploma or equivalent
• At least one of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Professional Coder (CPC), Certified Outpatient Coder (COC) or Certified Coding Specialist (CCS)
• One (1) years of experience in emergency, urgent care, and hospital environment.
• Experience using an encoder is preferred
• Experience using an electronic medical record is preferred
• Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, pharmacology, medical terminology and abbreviations
• Ability to identify physician signatures and interpret physician notes accurately in order to assign correct codes in a timely manner
• Federal laws and regulations affecting coding requirements
• Principles, practices and methods of current coding certificate required
• Modern office practices, etc.
• Knowledge of billing practices required, FQHC billing preferred
• Knowledge of medical records, EHR required
• Extensive 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 have good math skills and effective communication skills.
• Perform coding work requiring independent judgment with speed and accuracy
• Examining and verifying coding errors through audits
• Required in-services
• Communicating clearly and concisely, orally and in writing
• Ability to use the computer
• Ability to work independently to accomplish assigned work in a timely manner
• Ability to communicate with staff and the public, both in person and over the telephone, in a tactful manner and under difficult situations
• Understanding and carrying out verbal and written directions
• Follow NEC policies and procedures
• Works independently in the absence of supervision
• Basic computer skills
• Type 35-45 wpm
• CPC/COC/CCS/CCP/ RHIA or RHIT
• Professional Maturity: The ability to separate emotional feelings from the real issues at hand
• Responsibility: The ability to accept choices you have made and the results they have led to. Able to work independently
• Communication: The ability to write and speak effectively; actively listens to others, and give feedback
• Flexibility: Demonstrate responsiveness and adaptability following change initiatives
• Intelligence: Understand information and apply new knowledge
• Energetic: Exhibits high levels of energy and enthusiasm
• Organized: Efficient in structuring tasks to be accomplished
• Computer Savvy: The ability to use technology efficiently and effectively
• Customer Service: The ability to enhance customer satisfaction
• Job Knowledge/Technical Knowledge: Knowledgeable of current role and technical systems, and the impact it has on the organization
• Integrity and Respect: Demonstrates upmost level of integrity
• Interpersonal Communication: Writes and speaks effectively based on the psychological, relational, situation, environmental and cultural dynamics within the situation
• Collaboration and Partnership: Encourages participation from team members
• Manages Change: Demonstrates flexibility with changing environments
• Problem Solving: Resolve issues in a timely manner
• Attention to Detail: Follows procedures to ensure entry of data
• Organization: Uses time efficiently by prioritizing and planning work activities
• Judgment: Ability to make independent decisions
• Teamwork: Works with others to accomplish objectives and shows support for decisions
• Quality: Sets high standards to ensure quality in work performed
• Accountability: Takes responsibility for adhering to all company policies, procures, and performance expectations
• The physical demands for this position include: adequate vision, hearing, and repetitive motion
• Light physical activity performing non-strenuous daily activities of an administrative nature
• Ascending or descending stairs, ramps and the like, using feet and legs and/or hands and arms
• Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner
• Bending legs downward and forward by bending leg and spine
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