Medical Coder/Coding Specialist II

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Join Team Tidelands and help people live better lives through better health!

Position Summary: Responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT, and HCPCS codes to all outpatient, ED, and hospitalists accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Tidelands Health policy and procedure. Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responsible for resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement of service rendered and to maintain an industry standard clean claim rate. May assistant with writing appeals letters. Assist with training to include team members and physicians.

Position Responsibilities & Functions:

• Applies strong knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis and procedure codes.

• Analyzes medical records, interprets documentation, and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD‑10‑CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software to include Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material as required.

• Enters charges for procedures that are not soft coded as instructed for certain patient types.

• Adheres to all department coding/charging procedures, policies, guidelines, and quality standards.

• Consistently meets coding quality and productivity standards established by the coding department.

• Completes a daily basis case that have been assigned to them utilizing the appropriate work lists/work queues.

• Codes complex diagnostic and procedural accounts, which include but are not limited to the following:

  • Emergency Services, Hospitalist Services, Observation, Same day surgery, Clinical Accounts, Recurring

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines.

• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

• Works closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions.

• Have knowledge of payer guidelines related to MUE, Medical Necessity, LCD/NCD requirements and HIPAA/Compliance in order to take corrective actions to allow for payer processing for payment.

• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.

• Review and resolve account checks, clearinghouse rejection errors, denials, and charge review/claim edits daily.

• Assist Patient Financial Service (PFS) with written appeal letters, dispute determination responses, and redetermination to support reimbursement of services rendered.

• Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations.

• Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record.

• Verify accurate abstracting of discharge disposition

• Reviews accounts returned from various departments and processes corrections for clean claim submission or posts claim denial review for appeal.

• As assigned, assists in training new coders to become acclimated to the environment and in understanding internal coding policies and procedures, and documentation guidelines.

• Assists manager with special projects/other tasks as assigned

• Safeguards confidential and privileged patient information.

Other duties as assigned:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Working Environment:

• Office and Hospital Work Environment or Works in a private office space in the coder’s home in compliance with Tideland Health’s Remote/Telecommuter Policy.

• Must be able to work in a sitting position, use a computer and answer the telephone.

• Includes the ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments if appropriate.

QUALIFICATIONS

Experience:

• Minimum of two years of progressive on-the-job coding experience in an acute care hospital or physician's office or successful completion of Tidelands Health coding cross-training program

Education:

• High school graduate or equivalent, is required.

• Associate or Bachelor’s degree in Health Information, Nursing, or other related fields, or formal coding classes completed and passed preferred.

Certification/Credentialing:

Candidates must have at least one of the following certifications:

• Registered Health Information Administrator (RHIA®)

• Registered Health Information Technician (RHIT®)

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

• Certified Outpatient Coder (COC)

Knowledge/Skills/Abilities:

• Analyze clinical data and interpret information.

• Ability to assign ICD-10-CM, CPT and/or HCPCS codes to complex diagnoses and procedures in an integrated system of outpatient and emergency records.

• Solid knowledge of hospital documentation, and coding workflows and terminology; Solid understanding of and ability to apply Coding Clinic and other coding guidelines.

• Proficient at writing AHIMA-compliant physician queries

• Adept at comparing documentation, code assignment, and charge in the financial system for accuracy and completeness and elevating concerns to the appropriate manager

• Proficient in researching and responding to Business Office questions and/or questions by the payer

• Works collaboratively with PFS, Quality, Compliance, and other facility leadership

• Functional knowledge of facility EMR, 3M encoder, CDI tool, and other support software

• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency

• Strong analytical capabilities.

• Strong organizational skills.

• Advanced ability to function independently and be a self-starter

• Outstanding research skills and ability to use independent judgment to solve problems

• Handle multiple priorities.

• Listen and acknowledge ideas and expressions of others attentively.

• Converse clearly using appropriate verbal and body language.

• Collaborate with others to achieve a common goal through mutual cooperation.

• Influence others for positive and productive outcomes.

Physical Requirements: Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.