Coder Analyst Specialist, Clinical Document Integrity
Analyzes documentation in the medical record to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and CPT-4 codes. Abstracts and codes procedures in conjunction with the provider to code services rendered with correct coding initiatives. Abstracts and enters data from the medical records in order to maintain a database for statistics and reporting. Assists the Billing Department in timely billing and rebilling of patient information.
Responsibilities
- Reviews documentation in the medical record to determine ICD-10 CM and CPT-4 coding that is needed to comply with billing and reimbursement guidelines set forth by government entities.
- Verifies data in the medical record and accurately abstracts pertinent information for charge entry.
- Appropriately utilizes CPT-4 and ICD-10 current procedural coding standards in assisting the provider with proper selection and assignment of the principal procedure(s) and related diagnosis.
- Edits unbilled claim transmission reports daily and makes necessary corrections to ensure accuracy and timely billing.
- Participates in quality coding and audit reviews for each provider.
- Assists provider with coding questions for all services rendered.
- Assists other coders with coding questions to determine the most appropriate codes used for billing compliance and refers coding questions to the Operations Manager when additional research is needed.
- Contacts physicians for clarification and medical necessity.
- Reviews all encounters for accurate documentation and coding of services rendered.
- Communicates pending items and questions with office manager, CDI supervisor, and manager.
- Demonstrates ability to meet or exceed practice quality and quantity standards.
- Liaison between practice specialty and insurance company for benefit determination and claim rejections.
- Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Professional coding experience is preferred.
Minimum Experience:
Three (3) years of extensive diagnosis and procedural coding experience required.
Licensure Requirement: Must have and maintain a CPC coding certification through the American Academy of Professional Coders, or be registered as a Health Information Technician (RHIT) through the American Health Information Management Association.