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Certified Coder
5 months ago
Summary
Responsibilities include identifying and coding medical records, with special emphasis on Medicaid/Medicare, for the purpose of reimbursement and compliance with federal regulations according to the diagnosis and procedure of each patient using the ICD-10-CM classification system. Responsible to post charges and assist in education and training of physicians and staff regarding the coding process.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Responsible to participate in ongoing performance improvement activities to evaluate compliance with all coding guidelines.
Reviews patients’ medical record and assigns appropriate code(s) using the ICD- and CPT system. Records all surgical and designated diagnostic procedures and assigns appropriate procedure code. Requests information from physician and/or other clinical staff when not recorded on discharge or if information is incomplete.
Compiles and/or post charges accurately, timely, and in compliance with federal and state insurance guidelines.
Updates demographic and insurance information as necessary.
Forwards code updates to system support immediately upon notice of implementation.
Maintains current knowledge of ICD- and CPT coding guidelines.
Works with clinic and business staff to assure all claims are submitted correctly and assists in the formation of appeals to insure correct reimbursement for services provided.
Works with Physicians and staff on updating information by specialty. Participates in educating and training physicians and staff in coding.
Responsible to understand Medicare compliance regulations.
Participates in CPI program. Maintains compliance, is knowledgeable, and utilizes the guidelines of all state and federal laws and regulations as they pertain to the position including, but not limited to; Health Insurance Portability Accountability Act (HIPAA), Scope of Practice, Accreditation Standards, Occupational Safety and Health Administration (OSHA), Bureau of Primary Health Care/ Health Resources and Services Administration (BPHC/HRSA), National Committee for Quality Assurance/Patient Centered Medical Home (NCQA-PCMH), Centers for Medicare and Medicaid Services (CMS), Clinical Laboratory Improvement Amendment (CLIA), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other HRSA related regulatory functions and/or agencies that Family Circle of Care participates in.
Supervisory Responsibilities
This job has no supervisory responsibilities.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Use of Technology - Adapts to new technologies; uses technology to increase productivity; keeps technical skills up to date.
Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.
Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods.
Diversity - Shows respect and sensitivity for cultural differences.
Ethics - Treats people with respect; inspires the trust of others; works with integrity and principles; upholds organizational values.
Personal Appearance - Dresses appropriately for position; keeps self well groomed.
Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time.
Safety and Security - Observes safety and security procedures; reports potentially unsafe conditions; uses equipment and materials properly.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Associate’s degree in a related medical or business field required. Medical terminology and/or anatomy/physiology, ICD-10-CM coding training/workshop completion preferred. 2-4 years’ experience in an outpatient clinic environment and/or a combination of education and experience required.
Computer Skills
To perform this job successfully an individual should have knowledge Microsoft Excel Spreadsheet software and Microsoft Word Processing software. Working knowledge Electronic Medical Records, EPIC preferred. Must be proficient in EPIC within one year of hire date.
Certificates, Licenses, Registrations
CPC (Certified Professional Coder) credential from the AAPC preferred.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to walk; reach with hands and arms and talk or hear. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate to quite.
This job description is intended to be a tool to describe the primary purpose of the job and the key duties and responsibilities. The position description may not be inclusive of all duties and job assignments. Job duties and responsibilities may be added, deleted, and/or revised at the discretion of management. This is a description of the way this position currently performs the job functions and does not address the potential for accommodation, which would be addressed on a case-by-case basis.
