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Employee reviews, analyzes and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments for our professional staff. The primary function of this position is to perform ICD-9-CM, CPT and HCPCS coding for the employed health care providers of St. Joseph's Hospital. The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
1. Employee will assigns and sequences ICD-9-CM/CPT/HCPCS codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the physician are valid and complete. Abstracts all necessary information from the health record to identify secondary complications.
2. Abstracts all necessary information and assigns codes (ICD-9-CM/CPT/HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
3. Determines final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
4. Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party reimbursement agencies and special screening criteria.
5. Analyzes provider documentation to assure the appropriate Evaluation and Management (E&M) levels are assigned using the correct CPT code.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Coder must display teamwork and commitment while performing daily coding duties.
The coder should demonstrate initiative and discipline in time management and assignment completion.
§ Advanced knowledge of ICD-9-CM and CPT coding principles and rules
§ Intermediate knowledge of disease pathophysiology and drug utilization
§ Intermediate knowledge of MSDRG classification and reimbursement structures
§ Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures
§ Effective written and verbal communication skills
§ Coding proficiency demonstrated by successful completion of approved coding exercise
§ Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
§ 3 years of government and non-government payer inpatient coding and abstracting experience
§ 3 years of government and non-government payer outpatient surgical and procedural coding and abstracting experience
§ 2 years experience with encoders and computerized abstracting systems
§ Minimum: 1 year coding certificate program through AHIMA or other accredited coding program and High school diploma
§ Preferred: Associates degree Health Information Management Technology
Conifer - Dickinson, ND
Tenet Healthcare - 2 years ago