The Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all levels of an organization - clinical, financial, administrative, and information systems - that employ patient data in decision-making and everyday operations.
The Professional Coder is an expert in health information documentation, data integrity, and quality. Professional Coder classifies medical data from patient records, reviews patients' records and assigns numeric codes for each diagnosis. In addition, possesses expertise in the ICD-10-CM and CPT coding systems and responsible for auditing of appropriate diagnostic and procedural code to patient health records for purposes of document retrieval, analysis and claim processing. The Professional Coder ensures that integrity of data posted within the Revenue Cycle adheres to policies and compliance. Coordinates with clinical teams to improve documentation and coding activities to meet monthly expectations and goals. The Professional Coder ensures optimal coding is associated with medical records, data integrity, and quality of documentation is met.
Job Duties & Responsibilities:
Applies the appropriate diagnostic and procedural code to patient health records for purposes of document retrieval, analysis and claim processing.
Abstracts pertinent information from patient records. Assigns the International Classification of Diseases, Clinical Modification (ICD), Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, creating Ambulatory Patient Classification (APC) or Diagnosis-Related Group (DRG) assignments.
Obtains acceptable productivity/quality rates as defined per position expectations.
Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
Review of medical records concurrently prior to claim submission
Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.
Serves as the key point of contact for coding information.
Provides feedback and problem resolution.
Coordinates communication and process information between coding, providers, and administration.
Provides onsite coding and documentation education and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payer requirements and insurance rejection resolution.
Coordinates responses to provider questions along with Compliance and Clinical Informatics team members.
Coordinate with Manager and Director to Audit all aspects of Electronic Health Record.
Audit medical records for compliance.
Develop and enhance audit reports for medical records.
Develop and enhance Clinical Documentation Improvement function.
Develop and enhance audit procedures
Complete weekly and monthly expectation & audit reports for administration.
Identify opportunities for improvement.
Provides input for the provider newsletters and feedback to the Clinical Adoption team on training issues that need further development.
Maintains current knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.
Assist the IT teams in the design and configuration of system enhancements
Participate in the performance improvement program.
Gain understanding of the performance improvement process.
Apply the performance improvement model to your department's activities.
Participate and/or create performance improvement teams that lead to improvement in other hospital areas.
Educate and involve self in the hospital and department's performance improvement plans.
Assist in promoting a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.
Be open to change and actively support change.
Be open to others' ideas and points of view.
Perform other duties as assigned.
Promote department goals as well as the mission of the hospital.
Communicate goals to fellow staff members.
Demonstrate measurable goal achievement.
Maintain department policies and procedures.
Include requirements and guidelines from external agencies (i.e., Joint Commission, State of Wisconsin).
Maintain and/or communicate to appropriate party function backlog at a set time.
Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.
Demonstrate acceptance and training of student interns in the department, as directed.
Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations.
Function with a great deal of autonomy.
Ability to travel by car and/or air and be away from Rogers Memorial Hospital for extended periods of time.
Verbal and hearing ability required to interact with patients and employees. Numerical ability required to maintain records and operate a computer.
Ability to plan, control and direct all aspects of employee relations. Tact required to interact effectively with employees and professional staff. Logical thinking and discretion required to make decisions in initiating and implementing policies and procedures and standards.
Must be able to read and communicate through written, verbal and auditory skills and abilities.
Physically/Mentally able to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical.
Credentials: RHIA, RHIT, CCS, CCS-P, CDIP, CPMA, or CPC
Completion of anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding courses, required.
Minimum of two (2) years' experience of related coding experience directly applying codes, preferably in a psychiatric setting .
Proven success in facilitation and training.
Previous participation in the performance improvement programs, preferred.
Computer proficiency and working knowledge of software programs, including Windows packages.
Rogers Memorial Hospital