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JOB SUMMARY: Under limited supervision, performs coding on all diagnoses, procedures, professional services, and supplies. The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.
REPRESENTATIVE DUTIES Responsible for abstracting, coding, and sequencing the classification of medical and surgical procedures, professional services, diagnosis, supplies and treatment modalities. Selects the most accurate and descriptive codes from the listings of American Medical Association Current Procedural Terminology (CPT-4) Coding system, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM); and Healthcare Common Procedure Coding System (HCPCS). Assigns Diagnosis-Related Groups (DRGs) and performs coding compliance reviews. Abstracts and codes pertinent medical data into multiple software programs. Uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. Maintains the confidentiality of patient records and procedures. Follows official coding guidelines to review and analyze medical records. Extracts pertinent data from the patient’s health record, and determines appropriate coding for clinic reports and billing documents. Identifies codes for reporting medical services, supplies and procedures performed by physicians, and enters codes into computer system. Provides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Sends coding queries to providers to request missing information. Follows data entry procedures, logs patient record into computer system to assure accurate processing of information to track and report the information and optimize reimbursement. Reviews computer record for accuracy. Maintains manual and electronic filing systems. Retrieves, reviews, and compiles data for reports as directed. Reviews and analyzes medical records to assure the record is complete and accurate, includes signatures and supporting documentation, and meets the requirements for accrediting agencies and reimbursement agencies. Provides training and mentoring to new employees as needed. Performs routine audits independently and participates in performance improvement activities. Provide reports of findings and feedback to parties involved.
Performs other duties as assigned.
KNOWLEDGE and SKILLS · Knowledge of medical terminology and abbreviations; anatomy and physiology; major disease processes and pharmacology.· Knowledge of classification systems, including CPT-4, E&M, ICD-9-CM, and HCPCS nomenclature, coding rules and guidelines.· Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), AHIMA, and AAPC for assignment of diagnostic and procedural codes.· Knowledge of Health Information Management theory, principles, practices, techniques, concepts and policies.· Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966. · Skill in understanding medical billing procedures and protocols.· Skill in linking diagnosis to services and applying appropriate codes to diagnosis, procedures, evaluation and management, and supplies.· Skill in operating a personal computer utilizing a variety of software applications.· Skill in operating computerized medical data entry and information processing systems.· Skill in oral communication and presenting information to providers.· Skill in writing reports and other materials.
MINIMUM EDUCATION QUALIFICATION A high school diploma or GED equivalent.
MINIMUM EXPERIENCE QUALIFICATION Non-supervisory - One (1) year of coding experience in any of the following coding classification systems: ICD-9-CM, CPT, E&M, or HCPCS.
MINIMUM CERTIFICATION QUALIFICATION Must possess one or more of the following certifications: Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coding Specialist (CCS) and/or Certified Coding Specialist-Procedural (CCS-P).
ADDITIONAL REQUIREMENTS May be required to work outside the traditional work schedule. According to the needs of the organization, some incumbents in this job class may be required to obtain specific technical certifications.
MINIMUM PHYSICAL REQUIREMENTS The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. This position requires persistent repetitive movements of the hands, wrists and fingers and the ability to sit for long periods of time. May occasionally be exposed to infectious diseases. ANMC is not a latex free environment. Therefore, some latex exposure can be expected.