Clinical Coding Specialist II

Mô tả công việc

Analyzes physician/provider documentation contained in assigned complex outpatient and/or emergency/urgent care patient electronic health records to determine the first listed and all secondary diagnoses. Utilizes encoder software applications (including online references) in the assignment of ICD-9-CM codes and CPT-4®/HCPCS procedure codes for appropriate APC assignment. Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA), and Unified Revenue Organization/Ministry Organization (URO/MO), ICD-9-CM - International Classification of Diseases, 9th Revision, Clinical Modification, CPT - Current Procedural Terminology, APC - Ambulatory Payment Classification, AHIMA – American Health Information Management Association. JOB DUTIES 1.       Actively demonstrates the organization’s mission and core values, and conducts oneself at all times in a manner consistent with these values. 2.       Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information. 3.       Navigates the electronic patient health record and other computer systems in determination of diagnoses and procedures to be coded. 4.       Codes complex outpatient and/or emergency/urgent care patient records (as their primary work assignment) utilizing encoder software, in the assignment of ICD-9-CM, CPT-4®, and HCPCS codes. Assign codes in accordance with AHA Coding Clinic for ICD-9-CM, AMA CPT Assistant, AHIMA’s Standards of Ethical Coding, as well as URO/MO established guidelines. 5.       Validates charges by comparing charges with health record documentation as necessary. 6.       Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtained from the health record. 7.       Communicates effectively with clinical staff, physicians and office staff regarding documentation issues or needs. 8.       Collaborates with Regional Shared Services (HIM and Patient Financial Services) in resolving billing and utilization issues affecting reimbursement. 9.       Identifies concerns and notifies appropriate leadership for resolution. 10.   Tracks issues (i.e., missing documentation or charges) that require follow-up to facilitate coding in a timely fashion. 11.   Meets coding quality and productivity standards established by SJRMC. 12.   Abides by confidentiality requirements as they relate to the release of individual or aggregate patient information. 13.   Maintains up-to-date knowledge of changes in coding guidelines and regulations. 14.   Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior. 15.   Performs other duties consistent with purpose of job as directed.