Certified Coder

Responsible for the accurate and timely review, analysis, and assignment of ICD-10-CM, CPT, and HCPCS codes for outpatient and clinic services in accordance with official coding guidelines, payer requirements, and Boys Town policies.

MAJOR RESPONSIBILITIES & DUTIES:

Reads and interprets medical record documentation to include diagnostic and procedural phrases performed during the visit (e.g., observation, inpatient, surgery, clinic encounter, etc.) and then translates them into appropriate coding form.

Analyzes health record to identify relevant diagnoses, procedures, supplies, and modifier requirements for distinct patient encounters for a variety of specialties.

Applies knowledge of ICD-10-CM, CPT, and HCPC coding guidelines and notes to accept and assign the correct diagnosis, procedural, or supply/ service codes, as documented, and sequences them correctly within the encounter.

Clarifies conflicting or ambiguous information appearing in the medical record by consulting the appropriate physician or clinician to ensure sufficient documentation and accurate code selection.

Utilizes internal and external resource and reference systems such as Encoder and AAPC news bulletins to ensure accuracy and current coding selections are utilized.

Prioritizes caseload based on date of receipt and charge source (e.g., paper encounter, operative note, reference lab invoice, or electronic medical record. Charges worked via the EMR shall be worked according to modified date ready to ensure timely filing requirements are adhered to.

Reviews individual encounter level system-generated claim edits to correct or complete missing data elements.

Conduct focused coding/encounter audits across multi-specialty practices to include providing brief yet detailed accounts of findings as well as suggested action plans for corrected claims and provider/staff education to the Coding Leadership.

Resolves coding and reimbursement issues with Patient Financial Services staff and third-party payers and assists in implementing solutions to reduce back-end billing errors, while maximizing revenue and reimbursement opportunities.

Provides back-up to the Hospital Coding team as needed to meet all coding group KPI’s and metrics.

Abides by the Standards of Ethical Coding as set forth by the American Information Management Association (AHIMA) and adheres to official coding guidelines and organizational compliance.

Other Duties:
This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

KNOWLEDGE, SKILLS, AND ABILITIES:

Apply thorough knowledge of ICD-10-CM and HCPCS/CPT coding theory with sustained accuracy of 95% or greater, while consistently maintaining acceptable productivity metrics set for the Professional Coding team.

Knowledge of E&M coding guidelines for both clinic/outpatient and inpatient services

Apply a thorough knowledge of medical terminology, disease process, and anatomy and physiology.

Communicate clearly and concisely both orally and in writing with all staff, physicians, and patients in all aspects of the job to allow efficiency and promptness for patient care.

Ability to function independently, with minimal supervision, as well as part of a team

Type 30 wpm with at least 90% accuracy.

Make rapid and accurate arithmetic calculations.

Maintain current and accurate records.

Treat information in patient records with strict confidentiality.strong attention to detail and critical thinking skills,

REQUIRED QUALIFICATIONS:

High school diploma or equivalent required.

Certified Professional Coder certification (CPC or CPC-A) required.

PREFERRED QUALIFICATIONS:

Minimum of one year of recent applicable experience in coding with ICD-10-CM, and HCPCS/CPT preferred.

Extensive knowledge of medical terminology, disease process and anatomy and physiology preferred.

Experience working in Electronic Medical Record (EMR) preferred.

Working knowledge of 1500 vs. UB04 billing preferred.

Other Duties:
This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

PHYSICAL REQUIREMENTS , EQUIPMENT USAGE, WORK…