Reviews, analyzes, and codes medical record documentation to include, but not limited to, medical, diagnostic and procedural information for the correct ICD-9 and /or ICD-10 and/or CPT-4 HCPCS codes to the greatest specificity. Abstracts demographic and coding information into the information system accurately and completely. Reviews documentation for medical necessity. Audits orders and claims before submission for entirety and accuracy and to minimize claim denials. Assesses records and prepares reports. Develops effective working relationships with physicians and other stakeholders.
1. Evaluates medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the visit.
2. Compiles necessary documentation prior to coding review; when documentation is not available, performs the appropriate steps to obtain the necessary documentation per the department’s policies and procedures.
3. Ensures demographic information and documentation are congruent with scheduled or performed procedures.
4. Evaluates records and prepares reports of appropriate production metrics and coding feedback and maintains or exceeds established productivity and coding accuracy standards.
5. May monitors unbilled accounts.
6. Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes; offers physician opportunity to submit corrected documentation.
7. Notifies appropriate individuals of potential non-compliance with medical necessity requirements and when services are non-covered or not payable, as appropriate.
8. Corrects failed claim errors to billing edits, clinical trial codes, and other coding related errors.
9. Documents coding information, and takes appropriate actions in the Practice Management System in accordance with the department’s policies and procedures.
10. Assigning and sequencing codes accurately based on medical record documentation
11. Assigning the appropriate discharge disposition as necessary.
12. Entering physician practice statistical and reporting requirements.
13. Tracking their own continuing education credits to maintain professional credentials
14. Performs other duties as assigned.KNOWLEDGE, SKILLS, ABILITIES
Knowledge of ICD-9-CM/ICD-10-CM and CPT coding principles and guidelines.
Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system.
Knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to medical documentations, billing and coding.
Knowledge of Standards of Ethical Coding.
Skill and ability to communicate effectively both orally and in writing.
Skill and ability to research and analyze data, draw conclusions, and resolve issues.
Skill and ability to read, interpret, and apply policies, procedures, laws, and regulations; read and interpret medical procedures and terminology; develop training materials; make group presentations; exercise independent judgment; and prepare reports and related documents.
Skill and ability to maintain working relationships with physicians and other staff.
Skill and ability to review the work of others and maintain confidentiality.