Job Title
The Coder 2 is skilled in three or more types of outpatient, Profee, or low acuity inpatient coding.
The Coder 2 may code low acuity inpatients, one-time ancillary/series, emergency department, observation, day surgery, and/or professional fee, including evaluation and management (E/M) coding or profee surgery. For professional fee coding, team members in this job code are proficient for inpatient and outpatient, for multi-specialties.
The Coder 2 uses the International Classification of Disease (ICD-10-CM, ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology (CPT), and other coding references. These references ensure accurate coding and grouping of classification assignments (e.g., MS-DRG, APR-DRG, APC, etc.). The Coder 2 will abstract and enter required data.
Essential Functions of the Role
- Examines and interprets documentation from medical records and completes accurate coding of diagnosis, procedures and professional fees.
- Reviews diagnostic and procedure codes and charges in the applicable documentation system to generate appropriate coding and billing.
- Communicates with providers for missing documentation elements and offers guidance and education when needed.
- Reconciles billing issues by formulating the rationale for rejecting and correcting inaccurate charges.
- Works collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately.
- Reviews and edits charges.
Key Success Factors
- Sound knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area.
- Sound knowledge of transaction code sets, HIPAA requirements and other issues impacting the coding and abstracting function.
- Sound knowledge of anatomy, physiology, and medical terminology.
- Demonstrated proficiency of the use of computer applications, group software and Correct Coding Initiatives (CCI) edits.
- Sound knowledge of ICD-10 diagnosis and procedural coding and Current Procedural Terminology (CPT) procedural coding.
- Ability to interpret health record documentation to identify procedures and services for accurate code assignment.
- Flexibility and adaptability while also balancing requirements and regulatory and accreditation guidelines that are non-negotiables.
Qualifications
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 2 Years of Experience
- Must have ONE of the following coding certifications:
- Cert Coding Specialist (CCS)
- Cert Coding Specialist-Physician (CCS-P)
- Cert Inpatient Coder (CIC)
- Cert Interv Rad CV Coder (CIRCC) - Cert Outpatient Coder (COC)
- Cert Professional Coder (CPC)
- Reg Health Info Administrator (RHIA)
- Reg Health Information Technician (RHIT).