This position analyzes all patient records in an accurate and timely manner utilizing the ICD-9-CM, ICD-10 and CPT-4 classification systems. The employee is responsible for reviewing the patients’ medical records to ensure specificity of diagnoses, procedures and appropriate optimal reimbursement for the physician practice and/or professional charges. This position inputs abstract data into the system following established methods and procedures.
Reviews and analyzes patient medical records from imported charges and the selected ICD-9, ICD-10, HCPCS and CPT-4 coding to ensure patient records are accurately coded.
Sequences the diagnoses and procedures using coding guidelines for various insurance carriers.
Work with clinicians and physicians if code assignments are not straightforward or if documentation in the record is inadequate or unclear for coding purposes.
May assist with quality improvement initiatives and compliance training programs.
Abstracts and compiles data from patient medical records for appropriate optimal reimbursement for professional charges.
Reviews and works on the error report for coding issues.
Finalizes accounts within three (3) days of patients’ visit.
Directs problems with charges and billing discrepancies to the Medical Billing Manager for resolution as required. Follows up to ensure resolution.
Monitors unbilled reports for missing diagnoses weekly. Resolves any discrepancies in a timely manner to ensure appropriate optimal reimbursement for services.
Reports on any backlog to the Medical Billing Manager on a daily basis.
Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to outpatient diagnoses and procedures.
Maintains a thorough understanding of medical record practices, standards, regulations, Joint Commission, HCFA and other applicable regulatory and compliance standards.
Adheres and follows departmental policies and procedures.
Applies the clinic’s principles of safety in all work practices. Reports any identified safety risks or incidents per the clinic’s policies and procedures.
Maintains a neat, orderly and safe work area.
Follows all infection control and employee health policies and procedures at all times.
Maintains patient confidentiality at all times according to the clinic’s established policies and procedures.
Emergency duty may be required of the incumbent that includes working in Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or disasters, man-made or natural.
High School Diploma or GED required. Associate’s Degree preferred.
Two (2) to five (5) years of physician practice coding experience required.
Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC) or Certified Coding Associate (CCA) required.
Medical documentation, Medical terminology, Anatomy and Physiology knowledge preferred.