MEDICAL RECORDS CODER II(187968)
Full TimeGeneral Description of the Job Class
Coordinate/review the work of vendor outsourcing partners and assist with the training and continuing education programs. Code medical records utilizing ICD-10CM and CPT-4 coding conventions. Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement professional charges. Abstract information from medical records following established methods and procedures.
Duties and Responsibilities of this Level
- Ensure quality and quantity of work performed through regular audits and QC for vendor services, specifically in the area of Charge Review Edits and Claims Manager Edits.
- Monitor and track outsourcing vendor performance as it pertains to QC and Productivity
- Review and research the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10 CM and/ or CPT, HCPCS coding conventions, and payer-specific coding guidelines.
- Develop and assist training, presentations, and educational tools for any relevant topic as it relates to continuing education programs in areas of specialization, coding, operational workflow, and quality control.
- Collaborates with other departments and partners (e.g. Revenue Integrity, QA Team, Compliance Specialist, Internal Controls, Billing and Collections, and Revenue Managers) to ensure coding feedback to outsourcing vendors and team are provided.
- Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
- Consult with and provide feedback to physicians or departments on coding practices and conventions in order to provide detailed coding information. Communicate with clinical, ancillary staff, and revenue managers for needed documentation to ensure accurate coding.
Develop and maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-9-CM/ICD-10 CM and CPT-4 coding guidelines to inpatient/outpatient diagnoses and procedures.
Develop and maintain a thorough understanding of medical record practices, standards, regulations, Health Care/ Finance Administration (HCFA) and Uniform Billing(UB-04), CMS, and other payer policies and any health care relevant changes.
- Develop and maintain a thorough understanding of payer-specific guidelines as it pertains to edit review and denial management.
- Develop and maintain a thorough understanding of the payer-specific appeal process
- Develop and maintain a thought understanding of CMS and Palmetto Claim Processing Manual including the Smart Edits and Claim Rejection.
- Ensure active participation in a team event and departmental activities in the PRMO and DUHS
- Ensure compliance with PRMO and DUHS policies and code of conduct
- Assist with special projects as required
Medical Records Coder II – Vendor Support – PB Edits
This is a progressive coder/auditor position, with opportunity for development and growth, accountable for key strategic vendor education, and ensures coding accuracy for the vendor services. The ideal candidate has experience and knowledge in coding/billing, denials, payer guidelines as well as well-developed analytical skills in this area. The position is a forward-facing role that will have regular access/communication to our coding vendor partners. Coding certification is required and additional certification for auditing is preferred.
- Quality Control – (40%)Review of vendor work to identify erroneous coding patterns and errors specifically in the PB Charge Review and Claims Manager Edits.
Review of vendor work to identify incorrect coding decisions and system action
Review of vendor work to identify appeal structure and effectiveness including identifying areas of opportunity to ensure system enhancement and workflow improvement
Providing feedback and education to vendor services to address issues found in the QC process
Monitoring and tracking of QC results
Provide coding process analysis and support for the department as an expert for the Outsourcing partner QC team and supervisors - Vendor Education (30%)
Plan activities aimed at improving the Coding Vendor’s quality performance in operations
Design and implement strategies for enhancing the vendor’s work quality and increasing productivity.
Evaluate the effectiveness of improvement strategy through sustained tracking and monitoring of vendor’s related WQ.
Reporting of vendor-specific trends and issues to upper management
- Coding (30%)
Performing actual coding function to various coding WQs (i.e. PB Charge Review Edits, Claims Manager Edits, and Denials)
Performing necessary research and investigation to resolve coding related issues and enhancement the business process associated with job functions and responsibilities
Maintaining coding skills by continuing education and keeping abreast of regulatory healthcare-related changes and payers rule updates
Minimum Qualifications
Education
A high school diploma is required.
Experience
RHIA certification- no experience required RHIT certification- no experience required CCS certification- one year of coding experience required CPC or HCS-D certification- two years of coding experience required
Degrees, Licensures, Certifications
Must hold one of the following active/current certifications: Registered Health Information Administrator (RHIA) Hospital Coding Registered Health Information Technician (RHIT) Hospital Coding Certified Coding Specialist (CCS) Hospital Coding Certified Professional Coder (CPC) Homecare Coding Specialist-Diagnosis (HCS-D) Homecare Coding
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