Coding Specialist I
Vidant Medical Group - Greenville, NC

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Position Summary

Audit, code, bill and abstract physician clinic, hospital outpatient, inpatient, ED, Psych, and other specialties for professional billing services for a multispeciality physician organization. All activities must be accomplished in accordance with national and facility approved coding guidelines and rules and ambulatory payment methodologies. Responsible for applying the appropriate diagnostic and procedural codes to individual patient encounters and surgical procedures, as well as, providing guidance to physicians in identifying and resolving coding related issues, questions, or discrepancies.

Assist the accounts receivable team with researching and resolving insurance denial issues.Activities must be performed with adherence to Federal Compliance Regulations and Medical Necessity Guidelines. Average coding accuracy must be consistently maintained at 95% or better. Average number of records coded per week must meet minimum established quantitative standards. Average number of records audited per week must meet minimum established quantitative

standards. Completes statistical forms and tracking logs. Assists the Compliance Review Specialist in providing educational feedback to support providers. Performs coder on-call activity, charge edit duties, and additional duties as requested by Manager.

Responsibilities

1. Audit, code, bill and abstract physician clinic, hospital outpatient, inpatient, ED, Psych, and other specialties for professional billing services for a multispeciality physician organization. All activities must be accomplished in accordance with national and facility approved coding guidelines and rules and ambulatory payment methodologies. Responsible for applying the appropriate diagnostic and procedural codes to individual patient encounters and surgical procedures, as well as, providing guidance to physicians in identifying and resolving coding related issues, questions, or discrepancies.

Assist the accounts receivable team with researching and resolving insurance denial issues. Activities must be performed with adherence to Federal Compliance Regulations and Medical Necessity Guidelines. Requires successful completion of the Coder Proficiency Test; or an equivalent combination of education and experience.

Average coding accuracy must be consistently maintained at 95% or better. Average number of records coded per week must meet minimum established quantitative standards. Average number of records audited per week must meet minimum established quantitative standards.

Reviews the entire medical record in the EHR and paper charts to determine principle diagnosis, complications & comorbidities, secondary diagnoses, principle procedure and secondary procedures, applicable coding modifiers, and charges for dates of service.

Assigns codes for each of the above utilizing coding resources for CPT-4, HCPCS, ICD-9/ICD-10, and modifers. All coding decisions must be accomplished in accordance with national and facility approved coding guidelines and rules and ambulatory payment methodologies - at times, this may require the coder to research many reference manuals or query physicians for information to insure accurate code assignments. Additionally coding decisions must adhere to Federal Compliance Regulations and Medical Necessity Guidelines.

Sequences codes appropriately for optimal reimbursement and transmits codes from 3M Encoder and CodeCorrect tools into the EHR billing system. Completes the clinical billing process in EHR by verifying edit checks.

2. Contacts physicians, residents, and other health care professionals to clarify difficult medical record documentation to insure accurate code assignment.

Contacts providers and clinic personnel by phone, email, EHR In-basket and documented for future reference and to substantiate any appeals that may be necessary for reimbursement.

3. Completes statistical forms and tracking logs. All coders are responsible for completing a daily productivity form indicating the number of records coded for the day, (by service type), and the number of hours worked. Additionally the coders are responsible for completing weekly prouductivity reports that reflect all activities accomplished. Coders are responsible for completing audit records in Intellicode auditing software in a timely manner to record documentation compliance by provider.

4. Performs additional duties as requested by manager.

Auditors and coders with exceptional skills and tenure may be asked to assist with training of new coders and periodice coding quality reviews.

Attends and participates in educational programs or inserices to keep abreast of changes and/or developments in coding rules/regulations, medical necessity, and Federal Compliance Regulations. Maintains updated ICD-9-CM and CPT coding reference materials. Maintains current coding certifications.

Identifies records that have been scanned/indexed or documented to the wrong patient in the EHR system and notifies the appropriate individual.

Performs work with a team player attitude; is loyal to the department goals and objectives; and is supportive of management and colleagues.

Minimum Position Requirements

High School plus 1 year but less than 2 years of formal training or education: Formal Courses in ICD-9-CM coding,

medical terminology, and anatomy & physiology. Individual will be required to produce transcripts of successful

completion ( C or higher). CPC, CCS-P, RHIT, RHIA education.

It is strongly preferred that the individual be credentialed as an RHIA, RHIT, CCS or CCS-P, or be eligible to sit for one of

these examinations.

Coding certification exam must be successfully completed within 12 months of hire.

Less than 1 year Coding experience in an appropriate medical setting required.

Other Information 2 full - time vacancy.

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