Medical Coder

Job Family Description

Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of clinical care

Job Function Description

Jobs in this function provide coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes.

General Job Profile

- Moderate work experience within own function.

- Some work is completed without established procedures.

- Basic tasks are completed without review by others.

- Supervision/guidance is required for higher level tasks.

Job Scope and Guidelines

- Applies knowledge/skills to activities that often vary from day to day.

- Demonstrates a moderate level of knowledge and skills in own function.

- Requires little assistance with standard and non-standard requests.

- Solves routine problems on own.

- Works with supervisor to solve more complex problems.

- Prioritizes and organizes own work to meet agreed upon deadlines.

- Works with others as part of a team.

Minimum Educational Background

- High school education or equivalent experience.

Functional Competency & Description

Proficiency Level MCD_Translate Medical Terminology into Medical Codes B) Developing

-Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes

-Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines

-Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes

-Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes

-Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information

-Follow up with providers as necessary when responses to queries are not provided in a timely basis

-Utilize medical coding software programs or reference materials to identify appropriate codes

MCD_Make Medical Coding Determinations B) Developing

-Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)

-Apply post-query response to make final determinations -Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process

-Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.

-Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)

-Resolve medical coding edits or denials in relation to code assignment

MCD_Maintain Medical Coding Quality Standards B) Developing

-Provide information or respond to questions from medical coding quality audits

-Perform medical coding audits to evaluate medical coding quality

-Review medical coding audit results -Follow steps per agreement with medical coding audit results to resolve discrepancies

-Provide resources and information to substantiate medical coding audit findings

-Educate and mentor others to improve medical coding quality

MCD_Demonstrate Coding

-Related Business and Technical Knowledge B) Developing

-Apply understanding of National Correct Coding Edits to the coding process

-Demonstrate understanding of National and Local coverage determinations

-Demonstrate basic knowledge of the impact of coding decisions on revenue cycle

-Follow relevant professional code of ethics consistent with required certifications

-Attain and/or maintain relevant professional certifications and continuing education seminars as required

-Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others

-Utilize and navigate across clinical software applications to assign medical codes or complete reviews

Job Family Description

Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of clinical care

Job Function Description

Jobs in this function provide coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes.

General Job Profile

- Moderate work experience within own function.

- Some work is completed without established procedures.

- Basic tasks are completed without review by others.

- Supervision/guidance is required for higher level tasks.

Job Scope and Guidelines

- Applies knowledge/skills to activities that often vary from day to day.

- Demonstrates a moderate level of knowledge and skills in own function.

- Requires little assistance with standard and non-standard requests.

- Solves routine problems on own.

- Works with supervisor to solve more complex problems.

- Prioritizes and organizes own work to meet agreed upon deadlines.

- Works with others as part of a team.

Minimum Educational Background

- High school education or equivalent experience.

Functional Competency & Description

Proficiency Level MCD_Translate Medical Terminology into Medical Codes B) Developing

-Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes

-Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines

-Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes

-Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes

-Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information

-Follow up with providers as necessary when responses to queries are not provided in a timely basis

-Utilize medical coding software programs or reference materials to identify appropriate codes

MCD_Make Medical Coding Determinations B) Developing

-Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)

-Apply post-query response to make final determinations -Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process

-Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.

-Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)

-Resolve medical coding edits or denials in relation to code assignment

MCD_Maintain Medical Coding Quality Standards B) Developing

-Provide information or respond to questions from medical coding quality audits

-Perform medical coding audits to evaluate medical coding quality

-Review medical coding audit results -Follow steps per agreement with medical coding audit results to resolve discrepancies

-Provide resources and information to substantiate medical coding audit findings

-Educate and mentor others to improve medical coding quality

MCD_Demonstrate Coding

-Related Business and Technical Knowledge B) Developing

-Apply understanding of National Correct Coding Edits to the coding process

-Demonstrate understanding of National and Local coverage determinations

-Demonstrate basic knowledge of the impact of coding decisions on revenue cycle

-Follow relevant professional code of ethics consistent with required certifications

-Attain and/or maintain relevant professional certifications and continuing education seminars as required

-Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others

-Utilize and navigate across clinical software applications to assign medical codes or complete reviews