Job Description
JOB SUMMARY:
The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient and/or professional fee encounters using appropriate ICD10/ICDPCS, CPT, or HCPCs codes and appropriate coding software such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters.
EDUCATIONAL REQUIREMENTS None Required
CERTIFICATION & LICENSURE REQUIREMENTS Registered Health Information Admin (AHIMA) upon hire or Registered Health Information Tech (AHIMA) upon hire or Certified Coding Specialist (AHIMA) upon hire or Certified Coding Specialist Physician Based upon hire or Certified Professional Coder (AAPC) upon hire or Certified Inpatient Coder (AAPC) upon hire or Certified Outpatient Coder (AAPC) upon hire.
EXPERIENCE REQUIREMENTS One year coding experience preferred
SKILLS AND KNOWLEDGE Knowledge of ICD-10-CM, CPT, and HCPC coding rules and guidelines for code application, ability to work with others collaboratively and communicate efficiently, both orally and in writing. Knowledge of medical science, anatomy and physiology required. Ability to perform computer data entry. Experience with encoders or other coding software packages preferred.
ESSENTIAL FUNCTIONS:
- Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
- Provides interdepartmental coding assistance, as needed, to determine accurate coding assignment.
- Develops methodology to provide a coding process that is compliant with regulatory agencies including the utilization of reference materials such as, but not limited to, Center for Medicare Services (CMS) publications, Coding Clinic, CPT Assistant, etc.
- Facilitates optimization of revenue while maintaining compliance standards for the organization through varied venues and tasks (auditing/monitoring, training, facilitation of charges through the claim scrubber system, assisting with various patient or payor related charge/account inquiries, research on various coding/billing related topics as requested by various sources internal and external to the organization, etc.).
- Serves as an expert resource regarding CPT, HCPCS, ICD-10-CM, all other necessary coding systems, and regulatory guidelines for all internal and external parties.
- Serve as liaison for coding and billing staff to ensure accurate charge capture.
- Reports any documentation and coding improvement needs based upon review findings.
- Responsible for maintaining coding certification, knowledge and skills to successfuly perform job duties
- Provides initial and ongoing provider and staff training regarding appropriate code assignment
- Performs provider and peer coding audits as requested
- Assist with monitoring of internal controls for coding and billing.
- Facilitates external audit activities and reporting of such activities to the appropriate administrative personnel.
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