Medical Coding Specialist I

Position Title: Medical Coding Specialist I

Department: Health Information

Supervisor’s Title: Health Information Manager

I. Position Summary: Analyzes physician/provider documentation within the patient record to determine the principal and secondary diagnoses and procedures. Utilizes encoder software applications in the assignment of ICD10-CM codes and CPT-4/HCPCS procedure codes. Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA), and American Health Information Management Association (AHIMA).

II. Principal Functions and Responsibilities:

A. Navigates the patient health record and codes outpatient records utilizing encoder software, in the assignment of ICD-10, CPT-4 and HCPCS codes. Assign codes in accordance with AHA Coding Clinic for ICD-10, AMA CPT Assistant, AHIMA’s Standards of Ethical Coding, as well as Valor Health’s established coding standards and guidelines.

B. Abstracts additional health record information for use in data collection, retrieval of health care statistics, maintenance of required disease and operative indexes, quality assurance monitoring activities, and data base maintenance for use by hospital administration, committees, medical staff, and accrediting, licensing, and regulatory agencies.

C. Works closely with the Revenue Integrity Specialist for appropriate charge assignment

D. Validates charges, when necessary, by comparing charges with health record documentation.

E. Responds to and resolves automated edits in 3M.

F. Communicates effectively with clinical staff, physicians, and office staff regarding documentation.

G. Recognize opportunities for documentation improvement and formulate clinically credible queries.

H. Maintains the coding of hospital discharged records within 96-hours of discharge

I. Meets or exceeds productivity and quality expectations. This is monitored and reported on a monthly basis.

J. Abides by confidentiality requirements as they relate to the release of individual or aggregate patient information.

K. Maintains up-to-date knowledge of changes in coding guidelines and regulations. Participates in educational opportunities to enhance knowledge in coding and reimbursement systems.

L. Maintains and enhances professional growth and career development by participation in activities directly related to responsibilities, such as reading journals and coding articles, participating in education programs, webinars, and continuing membership in professional affiliations.

M. Other duties and responsibilities as assigned "Providing excellent healthcare and promoting quality of life in our community"

Position Qualifications/Requirements:

A. High School Diploma or GED equivalent, required

B. Associate or Bachelor’s Degree in health related field, preferred

C. Must have one of the following credentials: CPC (Certified Professional Coder), CCA (Certified Coding Associate), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist - Physician based), RHIT (Registered Health Information Technician), or RHIA (Registered Health Information Administrator), if not currently certified must pass the national exam within 18 months of employment

D. Minimum one year of Hospital or Physician coding/charging/billing experience preferred.

E. Knowledge of Medicare/Medicaid requirements, HCPCS guidelines, and CMS documentation standards

F. Advanced knowledge of chargeable items and services provided.

G. Possesses a comprehensive knowledge of medical terminology, anatomy and physiology, disease processes, and diagnostic and procedural coding.

H. Experience in utilizing both encoding software and paper coding books is preferred.

I. Understands payer coding and billing requirements, including National Correct Coding Initiatives (NCCI).

J. Perform basic reconciliation functions

K. Ability to analyze problems and brainstorm solutions

L. Ability to work independently and with minimal supervision

M. Proficient with computers, ability to analyze reports, create spreadsheets

N. Excellent communication skills

O. Have the ability to sit for prolonged periods while conducting data entry work

P. Excellent time management and organizational skills

Q. Proactive in issue identification and resolution

Physical Requirement: Sitting and working at a computer keyboard, standing while filing, walking, lifting, reaching, hand eye coordination, speaking Working Conditions: Primarily works in an office setting, potential exposure to patient elements in general.