Certified Coder

Primary Functions

This position is accountable for conversion of diagnoses and treatment procedures into codes using ICD-10-CM, CPT-4 and HCPCS. This position requires skill in the sequencing of diagnoses and procedures to optimize reimbursement. Ensures that patient episodes are coded in an accurate and timely manner

Essential Duties and Responsibilites

• Works appropriate coding-related account work queues, claim edit work queues, and any others as deemed appropriate by the Revenue Cycle Manager.
• Follows Epic coding and charging workflow guidelines and instructions per Epic training and as directed per the Revenue Cycle Manager.
• Performs medical necessity checks appropriately utilizing the CMS website for Medicare tests when these are brought to the coder’s attention prior to the patient’s encounter.
• Verify charges are appropriate while coding.
• Must be familiar with ICD-10 coding guidelines.
• Ensures that records are coded accurately using Epic and the 3M encoder.
• Ensure that medical necessity is met before the claim is billed to the patient’s insurance to the best of their ability.
• Ensures that patient episodes are coded within a minimal time frame depending on completeness of chart by utilizing Epic work queues and reports.
• Appropriately follows up on accounts that they have on hold due to documentation or billing issues.
• Reviews chart thoroughly to ascertain all reportable diagnoses and procedures.
• Contacts responsible physician professionally, tactfully, and timely utilizing the coding inquiry tab through Epic or In-Basket messaging for coding-related queries if diagnosis and/or necessary documentation is not available within the patient record.
• Codes all diagnoses and procedures in accordance to ICD-10-CM, CPT-4 and HCPCS coding principles and guidelines.
• Codes all patient episodes in accordance with government regulations and payer requirements.
• Meets productivity standard of assigning codes to patient episodes within five days of the date of service for outpatient services and seven days from the date of discharge for inpatient, skilled nursing, hospice and extended care services.
• Meets quality standards of having 98% of principal diagnoses and procedures appropriately and correctly coded.
• Reviews coding periodicals within 7 days of receipt.
• Ensures that the ICD-10-CM, CPT-4, and HCPCS coding resources are updated each year in collaboration with the Revenue Cycle Manager.
• Notifies the Revenue Cycle Manager whenever the coding of patient episodes is backlogged or behind the work deadline.
• Ensures data quality and optimum reimbursement allowable under the federal and state rules, laws and regulations.
• Acts as a resource person to hospital staff for coding and may provide education regarding coding changes/issues.
• Must be familiar with all charting and coding requirements, for all levels of care as deemed appropriate per the Revenue Cycle Manager.
• Collaborates closely with the Business Office personnel to resolve denied claims.
• Collaborates closely with the Business Office to resolve chart audits where codes are invalid or otherwise not present on the patient episode.
• Must be familiar with the following manuals: Administration/Organizational, Health Information Management Department, Emergency Preparedness and Safety.

Minimum Qualifications

• Credentialed RHIT, RHIA , CCS or other AHIMA recognized coding certification; at hire or within 6 months of hire.
• Prefer two (2) or more years’ experience in hospital and physicians coding.
• Must have the ability to work with associated technologies relevant to the position.
• Knowledge of diagnoses/procedures code assignment in accordance with ICD-9-CM, CPT-4, and HCPCS coding guidelines.
• Ability to work with physicians in a collaborative manner.
• Ability to comprehend complex instructions.
• Ability to work within deadlines.
• Ability to write correspondence.
• Ability to effectively present information in one-on-one and in groups to providers, nursing staff and other employees within the organization for coding education.
• Ability to apply common sense understanding to carry out instructions furnished in written or oral form.
• Ability to communicate well with individuals over the phone or in person.
• Must be detailed oriented.
• Must possess the ability to effectively communicate, both verbally and in written form, information system problems, needs, and solutions with all levels of the organization.
• Must possess knowledge of databases, spreadsheet applications, and word processing.