Coder I, Full Time, MSS Miramar FL: Memorial Practice Mgmt
Employment Type : Full-Time
Summary:
Reviews medical record documentation to assign codes to medical diagnoses, procedures and modifiers when applicable using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.
Detailed responsibilities:
- Reviews medical record documentation to determine all appropriate diagnostic, procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders) to code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.
- Assigns and sequences diagnostic and procedural codes including modifiers using appropriate classification systems. For hospital coding, reviews all encoder edits and assign modifiers as appropriate for all HIM assigned Current Procedural Terminology (CPT) codes. Assigns and sequences diagnostic, procedure codes (minimal) and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or HIM Coding policies and procedures. Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Researches medical record for any additional diagnoses documented to meet medical necessity.
- Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
- Enhances and maintains coding knowledge and skills.
- Reviews all appropriate work queues daily to address edits and make corrections following procedures and processes.
- Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
- For physician billing, collaborate with billing department to ensure all bills are satisfied. For hospital, route to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Make appropriate coding corrections when advised and follow procedure to notify billing.
- Communicate with insurance companies about coding errors and disputes (physician billing).
- Review and validate the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
- Submit daily productivity report to HIM manager by defined deadline.
- Meet and maintain HIM coding quality and productivity standards.
- Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
- Performs all other duties as requested.
Competencies and skills:
Essential:
- STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
- CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
- ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
- RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
- TEAM WORK: Contributes to fullest potential to achieve team goals.
Education:
Essential:
- High School Diploma or Equivalent
Credentials:
Essential:
Education equivalent experience:
Essential:
Other information:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures.
Required Work Experience: For HIM coder, one (1) year hospital based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System.
For HIM, Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA). For Physician Billing, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC.
Working conditions:
Essential:
- Bending and Stooping 40.00%
- Keyboard Entry 60.00%
- Kneeling 40.00%
- Lifting or Carrying 0 - 25 lbs Non-Patient 40.00%
- Pushing or Pulling 0 - 25 lbs Non-Patient 40.00%
- Reaching 40.00%
- Repetitive Movement Hand/Arm 60.00%
- Sitting 60.00%
- Squatting 40.00%
- Standing 60.00%
- Walking 60.00%
- Audible Speech 60.00%
- Hearing Acuity 60.00%
- Depth Perception 60.00%
- Distinguish Color 60.00%
- Seeing - Far 60.00%
- Seeing - Near 60.00%
- Computer Monitor 80.00%
Organizational Profile:
Memorial Healthcare System, consisting of 6 acute care hospitals, a nursing home, outpatient facilities, home health services and physician practices, provides quality, comprehensive care to the residents of the surrounding communities. We invite you to join one of the nation's leading healthcare systems, recognized for use of advanced technology and clinical informatics.
Memorial Support Services provides a variety of business services to support our facilities. The main offices are located in Miramar with satellite offices located throughout our system.
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.