Medical Coder

SUMMARY:

The Medical Surgery Coder will play a key role in reviewing and analyzing medical billing and coding for processing. The Medical Surgery Coder will review and accurately code ambulatory surgical procedures for reimbursement.

SPECIFIC KNOWLEDGE REQUIRED:

• Required certification in one of the following : CPC, RHIA, RHIT
• Minimum of 2 years acute care coding experience of all patient types Surgical, Outpatient, Inpatient, SDS and ER, with strong experience in Inpatient.
• Successful completion of formal education in basic ICD-9-CM/ICD-10/CPT coding, medical terminology, anatomy/physiology and disease process.
• Knowledge of computers and Windows-driven software
• Excellent command of written and spoken English
• Cooperative work attitude toward and with co-employees, management, patients, outside contacts
• Ability to promote favourable company image with patients, insurance companies, and public.
• Ability to solve problems associated with assigned task

ADDITIONAL SKILLS REQUIRED/PREFERRED:

• Obtain operative reports
• Obtain implant invoices, implant logs, and pathology reports as applicable
• Supports the importance of accurate, complete and consistent coding practices to produce quality healthcare data.
• Adheres to the ICD-9/ICD-10 coding conventions, official coding guidelines approved by CPT, AMA, AAOS, and CCI.
• Uses skills and knowledge of the currently mandated coding and classification systems, and official resources to select the appropriate diagnostic and procedural codes.
• Assigns and reports the codes that are clearly supported by documentation in the health record.
• Consults physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.
• Strives for the optimal payment to which the facility is legally entitled.
• Assists and educates physicians and other clinicians by advocating proper documentation practices.
• Maintains and continually enhances coding skills.  Coders need to be aware of changes in codes, guidelines, and regulations.  They are required to maintain 90% or above coding accuracy average.
• Codes a minimum of 50 cases on a daily basis.
• Assures accurate operative reports by checking spelling, noting omissions and errors and returning to transcription for correction.
• Codes all third party carriers and self- pay cases equitably for patient services and supplies provided.
• Adheres to OIG guidelines which include:
• Diagnosis coding must be accurate and carried to the highest level of specificity.
• Claim forms will not be altered to obtain a higher amount.
• All coding will reflect accurately the services provided and cases reviewed for the possibility of "unbundling", "up-coding" or down coding."
• Coders may be involved in denials of claims for coding issues.
• Some centers require a code disagree form be completed.  Coders are required to provide their supporting documentation to be presented to the center for approval. (Surg Centers call this a coding variance)
• Ensures the coding site specifics are updated as needed for each center assigned.
• Identifies and tracks all cases that are not able to be billed due to lacking information such as operative notes, path reports, supply information etc.  On a weekly/daily basis provide a documented request to the center requesting the information needed.
• Responsible for properly performing month end tasks within the established timeframe including running month end reports for each center assigned and tracking of cases that are not yet billed for the month.
• Cases will be reviewed as part of an in-house audit process to ensure quality and accuracy of claims.  Corrections may be needed after review.
• Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time

PHYSICAL REQUIREMENTS:

• Requires ability to use a telephone
• Requires ability to use a computer