CODING SPECIALIST - HIM OPERATIONS

Job Title: Coding Specialist

Job Summary:

Ensures all Outpatient Anesthesia Interventional Diagnostic Radiology and North Oaks Clinic Records, i.e. Emergency Department Series Observation and any other Outpatient records are coded accurately using ICD-10-CM and CPT diagnostic procedural and evaluation and management codes per applicable regulatory guidelines compliance policies and standards of ethical coding.

Responsibilities:

• Accurately codes abstracts records by reviewing all documentation including dictated reports and/or ancillary results as needed to assign the definitive diagnostic procedural and evaluation and management codes as substantiated by physician documentation.
• Assigns diagnosis and procedure codes as specified in the Official Guidelines for Coding and Reporting based on substantiated documentation in the record.
• If diagnoses cannot be substantiated due to lack of physician documentation, a physician query will be issued for clarification of diagnosis.
• Complete required abstracting.
• Assists with account and claim work queues.
• Maintains coding accuracy and quality per internal quality monitoring and quality standard of 97%.
• Maintains coding productivity standards as outlined below: • ED Diagnostic & E&M-66 days • ED E& M Only-80 days • OP ED Series Records-19 hours • L&D Observation-19 hours

Specialized or Technical Education:

• High School graduate or equivalent and up.
• RHIA RHIT CCS CCS-P or CPC CPC-A is required.
• Successful completion of Basic Coding Course Medical Terminology Course and Basic Human Anatomy.
• Working knowledge of computers and keyboards.
• Must be polite and able to promote positive public relations with medical staff co-workers and any other persons within the health system.

Manual or Physical Skill Required:

• Must have good visual acuity to determine the quality of work.
• Must have good hearing acuity to answer phones.

Physical Effort Required:

• Must be able to sit for extended periods.
• PHYSICAL DEMANDS: • Strengths • Sedentary • Push • Occasionally • Pull • Occasionally • Carry • Occasionally • Lift • Occasionally • Sit • Frequently • Stand • Occasionally • Walk • Occasionally

Minimum Experience:

• Minimum of two years of experience in coding evaluation and management services and procedures preferred.
• Or One year experience in chart auditing with ProviderClinic Staff education preferred.
• Or Minimum of one year of outpatient coding experience, assigning ICD-10-CM and CPT codes to outpatient records including but not limited to diagnostic procedural and EM codes preferred.

Required Credentials:

• Credentialed candidate with RHIA RHIT CCS CCS-P or CPC CPC-A.
• CPC-A without previous coding experience will be evaluated based on an internal testing method AHIMA-Based Coding Test.
• A passing grade of 80 must be achieved.

Certification Required:

• High School graduate or equivalent and up.
• RHIA RHIT CCS CCS-P or CPC CPC-A is required.
• Successful completion of Basic Coding Course Medical Terminology Course and Basic Human Anatomy.
• Working knowledge of computers and keyboards.
• Must be polite and able to promote positive public relations with medical staff co-workers and any other persons within the health system.

Working Conditions:

• Must be able to sit for extended periods.
• PHYSICAL DEMANDS: • Strengths • Sedentary • Push • Occasionally • Pull • Occasionally • Carry • Occasionally • Lift • Occasionally • Sit • Frequently • Stand • Occasionally • Walk • Occasionally

Job Requirements:

• Accurately codes abstracts records by reviewing all documentation including dictated reports and/or ancillary results as needed to assign the definitive diagnostic procedural and evaluation and management codes as substantiated by physician documentation.
• Assigns diagnosis and procedure codes as specified in the Official Guidelines for Coding and Reporting based on substantiated documentation in the record.
• If diagnoses cannot be substantiated due to lack of physician documentation, a physician query will be issued for clarification of diagnosis.
• Complete required abstracting.
• Assists with account and claim work queues.
• Maintains coding accuracy and quality per internal quality monitoring and quality standard of 97%.
• Maintains coding productivity standards as outlined below: • ED Diagnostic & E&M-66 days • ED E& M Only-80 days • OP ED Series Records-19 hours • L&D Observation-19 hours

Communication Skills:

• Must be highly motivated and a self-starter and work independently.
• Must be able to communicate effectively express ideas clearly actively listening and always follow appropriate channels of communication.
• Must be able to build and maintain cooperative working relationships.
• Must be able to inspire confidence from physicians and co-workers by performing and communicating in a highly professional responsive and supportive manner at all times.

Professionalism:

• Must adhere to hospital and department policies and procedures.
• Must remain knowledgeable of all AHA Coding Clinics for ICD-10-CM CPT& HCPCS updates and any other applicable coding guidelines per all regulatory requirements.
• Must follow standards of ethical coding and correct coding initiative guidelines.
• Must follow North Oaks Health Systems compliance programs and all federal and state regulatory guidelines.

Additional Responsibilities:

• Assist with Annual Provider chart audits promptly.
• Maintain a working relationship with coding vendor which includes but is not limited to reviewing charge data keying charge data acting as a liaison between Providers and coding vendor and assisting with denials.
• Review billing audits for NOPG Clinic Providers and performs follow-up education and re-audits as appropriate with providers and staff.
• Continuously evaluate the quality of clinical documentation to spot incomplete or inconsistent documentation for NOPG Clinic Provider encounters that impact charge and/or code selection.
• Communicates variances to the appropriate manager.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and the American Academy of Professional Coders.
• Assist in communicating updates for LCDsNCDs to applicable clinic staff.
• Keeps abreast of new technology in documentation charging chargemaster coding and abstracting software and other forms of automation and stays informed about transaction code sets HIPAA requirements and other future issues impacting the billing and coding function.
• Perform special projects or random audits.
• Perform Chargemaster reviews including but not limited to review all ICD-10-CM diagnoses CPT procedures and HCPCS codes for additions deletions or revisions.
• Perform charge master compliance audits.
• Conduct analysis and prepare reports as directed.
• Assist in preparation of action plans for compliance and/or Administration.
• Maintain coding competency and enhance coding expertise through ongoing educational programs applicable to coding and compliance.
• Maintain coding credentials and timely complete CEUs as required.
• Remain knowledgeable of all AHA Coding Clinics for ICD-10-CM CPT& HCPCS updates and any other applicable coding guidelines per all regulatory requirements.
• Use interpersonal skills effectively to build and maintain cooperative working relationships.
• Inspire confidence from physicians and co-workers by performing and communicating in a highly professional responsive and supportive manner at all times.
• Demonstrate consistent willingness to maintain a good working rapport with all personnel.
• Demonstrate responsiveness to others ensuring complete follow-up on matters requiring additional attention.
• Perform other duties as required and/or directed.
• Follow standards of ethical coding and adheres to correct coding initiative guidelines.
• Follow North Oaks Health Systems compliance programs and all federal and state regulatory guidelines.