Definition Benefits Supplemental Questions
Definition: Under general supervision of the HHS Manager, accurately translates patient information into alpha-numeric medical codes for submittal to insurance companies so the proper payment amount can be generated and paid for services rendered by SRPMIC healthcare providers. This job class is treated as FLSA Non-Exempt.
Examples of Tasks:Essential Functions: Essential functions may vary among positions and may include the following tasks and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be comprehensive listing of tasks performed by all positions in this classification.
1.Coding: Performs procedural and diagnosis coding for final submission to the Billing Specialists.
Accurately interprets medical records including diagnosis and procedures performed by behavioral and medical healthcare providers.
Stays informed about coding rules, federal and state regulations and insurance contracts including, but not limited to, the following:
International Classification of Disease (ICD-10) codes
Carrier Paid To (CPT) & Healthcare Common Procedure Coding System (HCPCS) codes and procedures
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) codes
ICPM (International Classification of Procedures in Medicine)
Certification of Disability Management Specialist (CDMS) coding and reporting knowledge
Communicates clearly with Physicians, patients and other healthcare professionals to clarify diagnosis and billing codes.
Coordinates with the Billing Specialist to identify codes that document services and procedures performed that pertain to billable services.
2.Information Management: Demonstrates proficiency with information management.
Ensures the safekeeping and confidentiality of all records as required by Community or applicable law.
Knowledge and working familiarity with electronic health records and/or RPMS.
Assists with transmitting data to the Billing Specialist and reviews then corrects data entry errors detected after transmission as required.
3.Miscellaneous: Performs other job related duties as assigned by the HHS Manager or the HHS Director.
Knowledge, Skills, Abilities and Other Characteristics:
Knowledge of the history, culture, laws, customs and traditions of the SRPMIC.
Knowledge of various insurance plans and limitations of various plans including the Arizona Health Care Cost Containment System (AHCCCS) and Medicaid.
Knowledge of insurance terminology including prefixes, suffixes and standard abbreviations used in the insurance industry.
Knowledge of medical terminology and medical codes that allow selection of the most accurate and descriptive code using the ICD-10 coding conventions and other resource coding material.
Knowledge of CDMS coding and reporting.
Knowledge of the federal Freedom of Information Act, Privacy Act and HIPAA laws as they pertain to the SRPMIC work environment.
Knowledge of the computer software including RPMS software components, patient registration, pharmacy, dental, maternal and child care, laboratory and patient care components used in entering and maintaining the database.
Skill deciphering terminology used in entering and maintaining the database.
Skill correlating generalized medical observations and systems (vital signs, lab results, medications, etc) to stated diagnosis in order to assign the proper billing code(s).
Ability to communicate effectively both verbally and in writing.
Ability to use various medical references independently.
Ability to maintain strict confidentiality of patience information.
Ability to operate a personal computer including MS Office and RPMS software.
Education & Experience: An Associate in Science (AS) or Associate in Arts (AA) degree from an accredited college or university in a health or closely related field required.
Two (2) year's Medical Coder or closely related experience required.
Must obtain coding certification credentials during employment (i.e., CPC, CCS, RHIA or RHIT).
Equivalency: Any equivalent combination of education and experience that will allow the applicant to satisfactorily perform the duties of the job may be considered.
Insurability: Must possess and maintain a valid Arizona Driver's License and meet the SRPMIC insurance standards.
Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check. Employees are subject to random drug and alcohol testing.
"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified Community Member, then a qualified Native American and then other qualified candidate.
In order to obtain consideration for Community member/Native American preference, applicant must submit a copy of Tribal Enrollment card or CIB which indicates enrollment in a Federally Recognized Native American Tribe by one of the following methods:
Documentation must be received by position closing date.
The IHS/BIA Form-4432 is not accepted.
Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.
Salt River Pima Maricopa Indian Community