Job Description
MedicalCoder/CodingSpecialist
JobType: 8:30AM-4:00PM(Mon-Fri)
Department: MedicalRecords/HealthInformationManagement
WorkLocation: Cranston,RI
Pay:$36.17
JobSummary
Weareseekingadetail-orientedandknowledgeable MedicalCoder toreview,evaluate,andanalyzeinpatientandoutpatientmedicalrecordstoensureaccuratediagnosticandproceduralcoding,completemedicalrecordabstraction,andappropriatehealthcarereimbursement.Theidealcandidatewillhaveastrongunderstandingofmedicalterminology,anatomy,physiology,pathology,ICD-10-CM,andCPT-4codingsystems,alongwithexperienceinterpretinghealthcaredocumentationandapplyingcodingregulations.
TheMedicalCoderwillcollaboratewithphysicians,medicalrecordspersonnel,billingstaff,andotherhealthcareprofessionalstoresolvedocumentationdiscrepancies,maintainaccuratepatientrecords,andsupporttimelyandcompliantbillingandreimbursementprocesses.Thisrolerequiresahighlevelofaccuracy,confidentiality,analyticalability,andknowledgeofMedicare,Medicaid,andotherthird-partypayerrequirements.
KeyResponsibilities
Reviewandevaluateinpatientandoutpatientmedicalrecordstoextractaccuratediagnostic,procedural,anddemographicinformation.
AssignappropriatediagnosisandprocedurecodesusingapplicableICD-10-CMandCPTcodingguidelinesandregulations.
Applycurrentcodingstandardsandreimbursementrequirementstosupportaccurateandappropriatefinancialreimbursement.
Ensurecorrectcodeselection,sequencing,anddocumentationofdiagnosesandprocedures.
Identifyincomplete,unclear,inconsistent,orquestionablemedicaldocumentationandrefercasestotheattendingphysician,MedicalRecordsDirector,orMedicalDirectorforclarificationandresolution.
Providecodingguidanceandtechnicalassistancetophysicians,medicalrecordspersonnel,andbillingstaff.
Collaboratewiththebillingdepartmenttomaintainaccuratedata,supportinternalcontrols,andminimizecodingandbillingerrors.
Verifyinformationdocumentedonpatientabstractforms,includingapplicablePSIabstractforms,andreviewsupportinginformationforaccuracyandcompleteness.
Usecomputersystemsandhealthcaredatabasestoverifypatientcoverage,insuranceeligibility,andapplicablereimbursementrequirements.
Ensurecodedandabstractedmedicalrecordsarecompletedandforwardedtothebillingdepartmentinatimelymanner.
Maintainaweeklystatuslogofadmissions,transfers,anddischargestotrackmedicalrecordsandensurerecordsareaccountedforandcompleted.
Abstractandenteraccuratemedicalinformationintofinancial,statistical,andbillingdatabases.
Maintainstrictconfidentialityofpatienthealthinformationandcomplywithapplicableprivacypoliciesandregulations,includingHIPAA.
Assistsupervisorsandmedicalstaffwithadditionalmedicalrecords,coding,documentation,andreimbursement-relateddutiesasassigned.
RequiredKnowledge,Skills,andAbilities
Extensiveknowledgeofmedicalterminology,anatomy,physiology,pathology,pharmacology,diagnostictesting,andmedicalprocedures.
StrongworkingknowledgeofICD-10-CMandCPT-4codingclassificationsystemsandapplicablecodingguidelines.
UnderstandingofMedicare,Medicaid,commercialinsurance,andotherthird-partypayerrequirements.
Knowledgeofhealthcarebilling,reimbursementpolicies,andmedicalrecorddocumentationstandards.
Abilitytoaccuratelyinterpretclinicaldocumentationandassignappropriatediagnosisandprocedurecodes.
Abilitytoidentifydocumentationdeficienciesandcommunicateeffectivelywithphysiciansandotherhealthcareprofessionalstoobtainclarification.
Stronganalytical,organizational,problem-solving,anddataabstractionskills.
Proficiencyinelectronicmedicalrecords,codingsoftware,andhealthcareinformationsystems.
Excellentwrittenandverbalcommunicationskillsandtheabilitytocollaborateacrossclinical,medicalrecords,andbillingdepartments.
Demonstratedcommitmenttoaccuracy,confidentiality,compliance,andtimelycompletionofassignedwork.
EducationandExperience
Candidatesshouldmeetoneofthefollowingeducationalorprofessionalqualificationpathways:
Graduationfromanaccreditedcollegewithaspecializationinmedicalrecordsscienceorhealthinformationmanagement.
Graduationfromanapprovednursingschool,togetherwithCertifiedCodingSpecialist(CCS)certificationthroughtheAmericanHealthInformationManagementAssociation(AHIMA).
CertifiedProfessionalCoder(CPC)certificationthroughtheAmericanAcademyofProfessionalCoders(AAPC),asapplicabletotheemployer'srequirements.
Anequivalentcombinationofeducation,professionalcertification,andrelevantexperiencethatdemonstratestherequiredknowledgeandcompetencies.
Experience
PreviousemploymentasaMedicalCoder,CodingAbstractor,CodingSpecialist,orinacomparablemedicalrecordscodingposition.
ExperiencereviewinginpatientandoutpatientmedicalrecordsandapplyingCPTcodingstandardsinahospitalreimbursementenvironment.
Demonstratedabilitytoabstractmedicalinformation,supportbillingprocesses,andresolvecodingordocumentationdiscrepancies.
PreferredQualifications
Experienceinanacute-carehospitalorotherapprovedinpatient/outpatienthealthcarefacility.
Experiencewithmedicalrecordabstraction,codingaudits,reimbursementreview,andbillingdatavalidation.
Familiaritywithhealthcarepayerpoliciesandelectronichealthrecordsystems.
Currentprofessionalcodingcertification,suchasCCSorCPC.
#J-18808-Ljbffr