The specialist is responsible for accurately converting diagnoses and procedures into medical codes to optimize reimbursement while adhering to ethical standards. They also act as a resource for hospital staff regarding coding changes and ensure data quality across all patient encounters.
Requirements summary
Candidates must have a high school diploma or equivalent and at least one year of medical coding experience, with a preference for coding certification (CPC, CCA, CCS, or CCS-P). Proficiency in ICD-10-CM/PCS, HCPCS, and CPT coding principles is required for this role.
high schoolprofessional certificateHCPCSICD-10-CMICD-10-PCSMedical terminologyChart reviewMedical codingCPT codingData qualityPhysician communicationBilling complianceHealth information managementCCI editsReimbursement optimizationCoding software
Job description
Description JOB SUMMARY
Accountable for conversion of diagnoses and treatment procedures into codes using an international classification of diseases. Requires skill in the sequencing of diagnoses/procedures to optimize reimbursement. Ensures that records are coded in an accurate and timely manner, while strictly adhering to the AHIMA Code of Ethics.
General requirements
Performs all job responsibilities in alignment with the mission and vision of the organization. Performs other duties as required and completes all job functions as per departmental policies and procedures. Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs). Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time. Wears protective clothing and equipment as appropriate.
GENERAL
SKILLS: Ability to communicate in English, both verbally and in writing. Additional languages preferred. Strong written and verbal skills.
Basic
Computer
Skills
WORKING
Conditions:
General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids, or infectious organisms. May be required to change from one task to another or different nature without loss of efficiency or composure Periods of high stress and fluctuating workloads may occur. May be scheduled as needed including overtime.
Physical
Requirments &
DEMANDS:
Have near normal hearing: Hear alarms/telephone/normal speaking voice.
Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors. Have good manual dexterity. Have good eye-hand foot coordination. Ability to perform repetitive tasks/motion. Continuously within shift (67-100%): Standing, Walking. Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance. Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder.
MISSION
Statement:
QUALITY
HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment.
JOB
Specific
COMPETENCIES: Reviews chart thoroughly to ascertain all diagnoses/procedures. Professional communication with colleagues in all forms. Coding aligns with documentation and physician queries are made for all necessary clarification. Refers chart to director, if there is a question regarding the diagnoses/codes. Utilizes coding/abstracting software. Codes all diagnoses/procedures in accordance to ICD-10-CM/PCS, HCPCS, and CPT coding and payer guidelines. All CCI edits are thoroughly reviewed and addressed. Meets quality standards of have 95% of principal and secondary diagnoses, procedures, and modifiers appropriately and/or correctly coded. Reviews coding periodicals within seven (7) days of receipt. Maintains CEU requirements of their certifying organization and Hospital Authority of Miller County. Work and correct all errors and denials on their coded encounters. Notifies director whenever work is more than 48 hours behind work deadline. Assists the director with state requirements and reports. Ensures data quality and optimum reimbursement allowable under the federal and state payment system. Acts as a resource person to hospital staff for coding provide education regarding coding changes/issues. Must be familiar with all charging and coding requirements. Maintains a good working relationship with all departments and medical staff.
Must be familiar with the following manuals: Administration, Health Information Management Department, Fire Safety, Emergency Management and Safety. All other duties as assigned.
Professional
REQUIREMENTS: Follows Code of Conduct policy. Adheres to dress code; appearance is neat and clean. Completes annual educational requirements. Maintains regulatory requirements. Maintains patient confidentiality at all times. Reports to work on time and as scheduled; completes work within designated time. Wears identification when on duty; uses computerized time clock system correctly. Completes in-services and returns in a timely fashion. Attends annual review and/or skills fair and department in-services, as scheduled. Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees. Complies with all organizational policies regarding ethical business practices. Communicates the mission statement of the organization.
GUEST
Relations
STANDARDS: (All guest relation violations are subject to disciplinary action up to and including termination): Always treat others in a friendly, helpful manner. Refers co-workers to proper sources when unable to provide an answer. Interacts with others in a professional and friendly manner. Takes interest in others and always gives full cooperation to fellow workers. Always maintains an open line of communication with other departments. Thoroughly familiar with the hospital and the services it offers.
OTHER:
Responsibility to
Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is help accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected. As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable.
OTHER
DUITIES: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Requirements
EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS: High school graduate or equivalent. One or more years of previous experience as a Medical Coder. Knowledge of billing and coding in accordance with ICD-10-CM/PCS, HCPCS and CPT coding principles for Rural Health Clinics, Critical Access Hospitals, and skilled nursing facilities. Ability to work with physicians in a collaborative manner. Coding certification required (CPC, CCA, CCS, CCS-P, or equivalent). >5 years of experience acceptable in lieu of certification.
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