Coder, Medical Billing and Coding, Healthcare Administration

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Reports to the Manager, Coding & Records. Reviews, codes, and analyzes medical records in order to abstract relevant data from patient medical records into the online computer system. Assigns DRGs to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Reviews and analyzes discharged patient medical records to ensure all applicable patient data is available for coding and abstracting by:
  • Checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient and inpatient records.
  • Obtaining accurate and complete patient data through the review of the medical record, discharge summary, history and physical, consultation, progress notes, laboratory, radiology, operative and pathology reports.
  • Coding all procedures on inpatient records (all payors) and outpatient surgical records according to ICD-9-CM Codes, CPT-4 or Physician E&M (Evaluation & Management) Level Code (as applicable).
  • Referring questionable diagnoses and sequencing issues to the physician for clarification.
  • Communicating with the Patient Accounts staff and coordinating with department Manager any questionable abstract or coding problems.
  • Assigning ICD-9-CM Codes and completing a coding summary.
  • Reviewing and evaluating error messages and all incompatible DRGs to the manager or coordinator for a second level review.
  • Completing medical records for abstracting. Resolving any medical necessity related issues.
• Completes Medical Record Data Entry Duties By:
  • Abstracting diagnosis and procedure codes into the Hospital computer system according to specified guidelines.
  • Designating APC assignment on outpatient medical records.
  • Assigning accurately, when applicable, a DRG or APC to Medicare, Medicaid and other required payor's records with the assistance of various computerized grouper software.
  • Abstracting professional E&M codes, professional procedure codes, and technical component procedures into the Hospital computer system charging module according to specified guidelines.
  • Accurate and timely entry of charges on ED and OBS charts according to guidelines if applicable.
• Ensures Accurate And Up-to-date Coding By:
  • Quarterly internal and external auditing.
  • Reviewing Coding Clinic and attending coding workshops to enhance coding skills.
  • Billing software edits.
  • For the coding of diagnostic reports, a productivity standard of 250 reports is to be met and medical necessity holds resolved (based upon an 8 hour work day).
  • For the coding of inpatient, ambulatory surgery/observations and emergency records, one of the following productivity standards must be met (all include data entry and are based upon an 8 hr work day):
  • Inpatient Records:
    Coder I (15-19)
  • Ambulatory Surgery/Observation Records:
    Coder I (28-43)
  • Emergency Records Facility Records:
    Coder I (50-69)
  • Emergency Records Professional Records:
    Coder I (60-79)
• Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Completing other job-related duties and projects as assigned.
• Associate Complies With The Following Organizational Requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established time frames.
  • Completes annual employee health requirements within established time frames.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
  • Consistently utilizes appropriate universal…