Certified Coder

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Regular Full Time IT and HIM CIHA, CHEROKEE, NC, US 1 Attachments

Primary Function

The incumbent performs highly technical and specialized functions for the Cherokee Indian Hospital Authority. The employee reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement. The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement.

The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

Job Description

• The incumbent assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnosis and procedure for documented information.
• Assures the final diagnosis and operative procedures as stated by the physician are valid and complete.
• Abstracts all necessary information from the medical records to identify secondary complications and co-morbid conditions.
• Abstracts all necessary information and assigns codes (ICD-10, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
• The incumbent determines the final diagnosis and procedures stated by the physician or other health care providers are valid and complete.
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
• Operates RPMS and EHR peripheral equipment (CRT and printer) for the purpose of key-entering data for the process of updating patient information files and of exporting said data to the Nashville Area Office.
• Performs all duties according to established safety procedures and tribal policy.
• Performs other duties assigned.
• Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures, and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Qualitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party reimbursement agencies and special screening criteria.

Education/Experience

• RHIA, RHIT or CCS, CCS-P or CPC certification is required.
• Must have a minimal of one year medical coding experience.
• The incumbent is expected to enroll in continuing education courses to maintain certification.
• Six to twelve months would be required to become proficient in most phases of the job.

Job Knowledge

• Advance knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record.
• Advance knowledge of medical codes involving selections of most accurate code using the ICD-10-CM, Volumes 1-3, CPT, HCPCS, and official coding guidelines.
• Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-10-CM code.
• Advance knowledge of…