Coder Physician

Essential Job Functions

• Responsible for abstracting, coding, sequencing, and interpreting clinical information from inpatient, outpatient, emergency department, pro-fee, and clinical medical records.
• Responsible for assigning correct principal diagnoses, secondary diagnoses, and principal procedure and secondary procedure codes, with attention to accurate sequencing.
• Utilizes technical coding principles and DRG/APC reimbursement expertise to assign appropriate codes.
• Abstracts and codes pertinent medical data into multiple software programs and/or encoders. Follows official coding guidelines to review and analyze health records.
• Maintains compliance with both external regulatory and accreditation requirements and state and federal regulations.
• Extract pertinent data from the patient’s health record and determine appropriate coding for reports and billing documents.
• Identifies codes for reporting medical services and procedures performed by physicians. Enters codes into various computer systems dependent upon the various clients.
• Track and document productivity in specified systems and maintain productivity levels defined by the client.
• Maintain a 95% quality rating.

Perform duties in compliance with the Company’s policies and procedures, including, but not limited to, those related to HIPAA and compliance.

TITLE: Coder I, Professional

DURATION: 24 weeks

LOCATION: fully remote

JOB SUMMARY: Primarily focuses on coding of moderate complexity, such as outpatient or inpatient evaluation and management and minor procedures.

RESPONSIBILITIES:
• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.
• Identifies all billable services. Reviews all applicable data sources, including but not limited to, electronic health record, inpatient admit, discharge and transfer (ADT) reports, operative logs (aka Op Logs), nursing home visit documentation, procedure reports generated from non-the electronic health record systems, etc.
• Reviews medical record documentation in the electronic health record and/or on paper. Identifies, enters and posts CPT-4 and ICD-10 codes to the electronic health record. Identifies need for medical records from outside the organization and follows established procedures to obtain. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Consults with physicians/ providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes. Provides education around documentation improvement for maximum patient care.
• Assists physicians/providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to leaders.
• Reviews and resolves charge sessions that fail charge review edits, claim edits, and follow up denials. Works to improve billing based on findings/resolution of errors.
• Is watchful for charge review, claim edit, and coding-related denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.
• Manages assigned charge review, claim edit, and coding follow up work queues.
• Performs other duties as assigned.

MINIMUM REQUIREMENTS:
• Education: High School diploma/GED or 10 years of work experience
• Certification:
o Certified Coding Associate (CCA) - American Health Information Management Assoc (AHIMA)
o OR Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Assoc (AHIMA)
o OR Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC)
o OR Certified Professional Coder (CPC®) - American Academy of Professional Coders (AAPC)
o OR Registered Health Information Administrator (RHIA) - American Health Information Management Assoc (AHIMA)
o OR Registered Health Information Technician (RHIT) - American Health Information Management Assoc (AHIMA)
o OR Certified Professional Coder Apprentice (CPC-A) - American Academy of Professional Coders (AAPC)
o OR Certified Coding Specialist (CCS) - American Health Information Management Assoc (AHIMA)
TITLE: Coder I, Professional