Job Description
Analyze medical records and assign codes to classify diagnoses and procedures to support the reimbursement system, medical necessity, and compliance policies.
Job Duties:
- Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM/CPT codes for billing.
- Perform internal and external reporting, research, and monitor regulatory compliance.
- Accurately code inpatient/outpatient conditions and procedures as documented in the ICD -10- CM Official Guidelines for Coding and Reporting.
- Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors.
- Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for inpatient and outpatient encounters.
- Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.
- Utilizes technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10-CM diagnoses and procedures.
- Assigns present on admission (POA) value for inpatient diagnoses.
- Reviews documentation to verify and, when necessary, correct the patient disposition upon discharge.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
Education:
Associate Degree preferred. RHIA, RHIT, or CCS Certification required.
Training/Experience:
Minimum of 3 years experience highly desired.
Skills/Qualifications:
- EMR/EHR Experience
- Customer Service
- Time Management
- Organization
- Attention to Detail
- Professionalism
- Quality Focus
Type: Full-time