Coder 2 - Clinic
To review and audit Network Provider medical records for documentation and coding compliancy and quality with federal and state laws and regulations.
Responsibilities
Quality and Performance Improvement
- Research, develop and implement standardized process for quality monitoring of inpatient and outpatient coding and abstracting. Conduct quality audits for coding according to pre-established criteria in coordination with the Coding and Reimbursement Specialist. Assist Management with evaluation of functions and processes of the coding area to determine opportunities to improve the efficiency and quality of the coding area. Implement innovative ideas and process changes.
- Attend meetings as required and strive to improve the quality of meetings by taking an active role in meeting topics. Participate in educational programs, in-services, and training sessions in an effort to share expertise with others and further the quality of education and personal growth provided to new personnel, volunteers, and interning students.
Collaboration and Partnership
- Establish and maintain interdepartmental relationships with Network providers to facilitate cooperation and compliance. Assist the Physician Network, Revenue Management Department and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitor and evaluate compliance with documentation standards to identify trends, issues, risk areas, and opportunities of education and process improvement.
- Collaborate with Management to identify and coordinate educational needs based audit results and new technologies. Provide support to the Coding and Reimbursement Specialist of monthly statistics and educational programs to staff on a regular basis. Provide technical assistance to the Systems Specialist for authorized coding database retrieval and identification and resolution of software and system functionality.
Other Duties As Assigned
- Performs other duties as assigned or requested.
Qualifications
- Associates degree, Bachelors degree, or coding certification (CCS or CPC) with 3 years' experience OR 5 years' experience in medical coding without degree or certification
- Thorough knowledge of medical terminology, managed care financial agreements; Thorough knowledge of CPT-4, HCPC, and ICD-9 codes