Under direct supervision, the E&M/ Specialty Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from appropriate documentation in the medical record, assigns codes and modifiers with ICD-CM, CPT and HCPCS Level II codes. All work is performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic pub... more details
Description:
Job Summary:
Under direct supervision, the E&M/Specialty Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from appropriate documentation in the medical record, assigns codes and modifiers with ICD-CM, CPT and HCPCS Level II codes. All work is performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines.
Essential Responsibilities:
Review Medical Records to identify diagnoses/procedures.
Under supervision, codes all diagnostic and operative information from the medical record using ICD-CM, CPT and HCPCS coding classification systems.
Verifies and abstracts all medical data from the record to assign appropriate codes for the following settings: Inpatient Hospital (IP), Hospital Emergency (ED), Hospital observation (HOPS), Hospital Ambulatory (HAS) Hospital Outpatient (HOV) and Medical
Office.
E&M/Specialty Coder may require specialty coding and will remain part of the responsibilities as long as business dictates.
Corrects data as appropriate.
Review Medical Records to resolve Ingenix and HealthConnect Coding Edits.
Under supervision, identify and resolve coding related edits by reviewing the medical record and ensuring that all data and codes are consistent with ICD-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, MediCal, USDOL, as well as KP Regional and Local policies.
Corrects data as appropriate.
Work Organization and Prioritization.
Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved, in a timeframe that will assure compliance with regulatory, billing and SOX requirements.
Completeness of Medical Record Data.
Under general supervision, interacts with clinical contracts to clarify and promote accurate documentation of patient diagnostic and procedural information.
Enters patient information into the computerized medical record and billing systems, ensuring the accuracy and integrity of the medical record data abstracted or encounter
data corrected, prior to submitting the data.
Ensures timely data completion by meeting coding/abstracting productivity/quality standards established for the E&M/Specialty Coder position in the current Coder Work At
Home agreement.
Provides feedback to monitor service provider and line of business compliance with regulatory requirements.
Confidentiality / Security of Systems Maintains and complies with policies and procedures for confidentiality of all patient records.
Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems.
Other Duties: Answers the telephone promptly and identifies themselves and the department.
Acts as a resource person to other departments regarding coding questions and issues.
Performs other duties as assigned.
Grade 594
Basic Qualifications:
Experience
Minimum two years, within the last three years, certified professional coding experience.
Education
High School Diploma or GED.
Completion of classes in medical terminology, anatomy, physiology, current ICD CM and CPT coding conventions, and disease process from an accredited program is required.
License, Certification, Registration
Professional Coder Certificate OR Registered Health Information Technician Certificate OR Coding Specialist Certificate - Physician Based
Additional Requirements:
Achieve a minimum score of 80% on the E&M/Specialty Coder test.
Basic knowledge of and use of computer keyboard
Must be able to meet production and quality standards established for the position.
Demonstrated knowledge of anatomy, physiology, medical terminology and disease processes.
Demonstrated ability to understand the clinical content of a health record.
Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing.
Basic knowledge of reimbursement methodologies and conventions.
Knowledge of rules and guidelines for current coding classifications.
Practical knowledge of hospital and/or physician clinic based revenue cycle
Practical knowledge of professional series coding and billing in a multi-specialty environment.
Practical knowledge of government and other payer coding, billing and collection rules and regulations.
Must maintain current coding credential and perform associated Continuing Education Units.
Must abide by the AHIMA and/or AAPC code of ethics.
Must be willing to work in a Labor Management Partnership environment.
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