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Coder II - Medical Coding

Department:  Business Services
Status:  Full Time
Shift:  1st

Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM, ICD-10-PCS and/or CPT-4 codes for billing, internal and external reporting, research and regulatory compliance activities. Resolve error reports associated with the billing processes, identify and report error patterns and when necessary assist in the design and implementation of work flow changes to reduce billing errors. Must meet ongoing productivity and quality metrics as established within the department for each level. Coder may work remote if minimum technology requirements, productivity and quality requirements are met and they sign, and adhere to, the Telecommuter Work Agreement.

 

Essential Functions

Level I:

  • Identifies chargeable items and facility level for emergency department visits, including observation services, and enters them into billing system.
  • Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.
  • -OR-
  • Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-10-CM and CPT-4 procedures.
  • Assigns codes for diagnoses and treatment according to the appropriate classification system for ancillary outpatient encounters, including modifier assignment.
  • Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.

 

Level II:

  • Review OASIS for documentation inconsistencies and accuracy
  • Plan of treatment review for an accurate reflection of patient's condition and diagnosis
  • Conduct reviews of home health and hospice coding and provide recommendations for appropriate coding based on current coding guidelines
  • Provide written feedback to field staff related to documentation and coding
  • Maintain proficiency/knowledge of OASIS Data set items, home care reimbursement, and compliance as related to OASIS regulations and requirements
  • Maintain proficiency/knowledge of coding guidelines
  • Maintain Coding Certification
  • Develop and maintain knowledge of software systems utilized by the home health and hospice agency
  • Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-10-CM and CPT-4 procedures.
  • Assigns codes for diagnoses, treatment and procedures according to the appropriate classification system for Outpatient Procedures and Emergency Department encounters, including modifier assignment.
  • Identifies chargeable items and facility level for emergency department visits, including observation services, and enters them into billing system.
  • Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards

 

Education, Training and Experience

Level I

Required:

  • High school diploma or equivalent.
  • Two years of hospital acute care OP diagnostic coding experience or graduation from a CAHIM accredited HIT program and is CCS eligible or RHIT eligible.

 

Preferred:

  • Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT and/or RHIA. CPC and/or CPC-H will be considered with relevant outpatient coding experience.

 

Level II

Required:

  • Two years of progressive hospital acute care coding experience including ER , outpatient procedure and same day surgery.
  • Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT and/or RHIA. CPC and/or CPC-H maybe considered with relevant outpatient coding experience

 

Skills or Other Qualifications

Required:

  • Ability to code and maintain corporate/department specific quality standards and meet productivity standards as documented by the department and organization.
  • Knowledge of medical terminology, anatomy and physiology, disease process and minor surgical procedures.
  • Knowledge of accepted medical abbreviations and their meanings.
  • Knowledge in the use of specialized references such as the ICD-9-CM and CPT-4 books, medical dictionaries and texts, and medical journals.
  • Must have extensive knowledge of Coding Clinic, CPT Assistant, and all official coding guidelines.
  • Advanced knowledge of hospital information systems, encoders and other technology to facilitate a successful virtual work environment while maintaining maximum communication and adhering to HIPAA security standards.
  • Advanced knowledge of MS Excel, Word and Outlook functions.
  • Abides by the standards of Ethical Coding as set forth by the American Health information Management Association (AHIMA) and adheres to all official coding guidelines.
  • Technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs and work efficiently in a virtual environment.
  • Strong written and verbal communication skills.
  • Ability to think/work independently, yet interact positively with a remote team.
  • Advanced problem-solving skills.
  • Familiarity with current healthcare based technology, coding, and Electronic Health Record (HER).
  • Attention to detail is crucial to this position.

 

Preferred:

  • Knowledgeable in Revenue Cycle department functions relating to Ambulatory Payment Classification (APC) grouping, denials and edits.


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Medical Coding, Medical, Telecom, Telecommunications, Physiology, Healthcare, Technology

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