The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
Other information:
Job Summary
Responsible for the accurate coding and abstracting of inpatient and outpatient diagnoses and procedures into codes using an international classification of diseases. The Certified Coder will ensure that records are coded in an accurate and timely manner as well as work closely with physicians and documentation nurses or specialists to consistently and accurately translate clinical documentation and medical records into ICD-10, HCPCS, CPT, Modifiers and assign Ambulatory Payment Classifications (APC) and/or Diagnosis-Related Group (DRG) codes. To ensure success you need to make judicious decisions on which codes to assign in each instance, and function to a high level of accuracy. Through these efforts, the individual within this role will identify and report error patterns, resolve errors or issues associated with coding and billing processes, and when necessary, assist in the design and implementation of workflow changes to reduce billing errors. The individual within this role will be expected to perform essential duties, including but not limited to reviewing coding and billing processes for accuracy, acting as resource for other coders, supporting adherence to quality expectations and productivity standards, and hence ensuring optimal reimbursement. Location/Department specific tasks and competencies may apply. The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
Essential Functions
Accurately applies ICD-10, HCPCS, CPT, APC or DRG codes for both routing and complete procedures as well as maintains or exceeds the standard level of quality and productivity established by Skagit Regional Health. Coding responsibilities could include Outpatient, Hospital Inpatient, Emergency Room and Professional Services. Maintains up to date knowledge and provides guidance on requirements set forth by CMS, other third party payor requirements, the American Hospital Association Official Coding Guidelines, and/or American Academy of Procedural Coding Guidelines and/or American Medical Association’s CPT guidelines. Ability to understand and code CCI Edit Standards. Monitor and reviews regulatory changes that impact clinical documentation and reimbursement requirements to ensure accurate and compliant coding. Reviews clinical, and hospital documentation in order to assign diagnostic and procedural codes for inpatient and outpatient medical records according to the appropriate classification system. Review/Audit patient disputes surrounding inappropriate coding in a timely manner, providing remedy as needed. Monitors documentation turnaround time and productivity, and follows up on un-coded accounts or with physicians and other clinical staff as needed. Efficiently manages multiple tasks, prioritizing workload in an efficient manner. Reviews system-generated error reports to correct or complete missing data elements. May be tasked with generating reports and/or analyzing data related to evaluation and management code utilization, CPT Code application, reviews and corrects coding denials in a timely fashion, reimbursement per contracted terms, etc. Conducts quality assurance activities, reports results to management and provides feedback and training to other coders. Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities. Acts as a liaison and coding expert to ancillary departments, administration, and physicians by answering questions or providing support as issues arise. Assists with design and implementation of related applications and updates to encoder and coding and abstracting application(s). As needed, reviews obtained authorizations to ensure they align with the procedure scheduled or performed. Abides by the standards of ethical coding and adheres to official coding guidelines are inherent to this position. Performs other duties as assigned. Successfully meets monthly or quarterly goals set by management. Works Epic tasks and work-queues daily. Maintain ability to effectively utilize Microsoft Office (Outlook) and department specific software applications to perform work. Communicates clearly both verbally and in writing. Communicate effectively and cooperatively in the workplace. Complete all mandatory learning requirements in a timely manner. Maintain current licensure and/or certification as required. Attend and actively participate in all department, team and/or committee meetings. Comply with all Skagit Regional Health, department and location specific policies and procedures. Perform other duties as assigned by Supervisor or designee.
Education
High School Diploma or equivalent (GED) required. Completion of college level courses or relevant experience in anatomy, physiology, and medical terminology preferred, Additional training or education in coding preferred. Associate or Bachelor’s degree in health administration, HIM or other related field or equivalent work experience preferred. Certified Coder within 6 months of hire date - CPC, RHIA, RHIT, CCS, or CCA Certifications.
Experience/Training
Minimum of two (2) years progressive on the job experience, three (3) years preferred. Inpatient, Outpatient, Emergency Room/Dept. and/or Professional Services, ICD-10-CM, CPT, ASA Coding and abstracting of multiple case types within the past Two (2) years required. Skills assessment examination is required for new hires. Experience in Epic Systems preferred. Certified Coding experience, including Inpatient and or Specialty coding, Outpatient, Emergency Room and Professional Services Coding preferred.
License/Certifications
Certified Coder within 6 months of hire date - CPC, RHIA, RHIT, CCS or CCA Certifications. Must keep credentials/licensure current.
Other Skills
Effective verbal, written and interpersonal communication skills required. Well-developed problem solving and analytical skills required. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Excellent time management and prioritization abilities. Capable of both following and providing detailed instructions. Knowledge of current coding rules and guidelines (CPT, ICD – 10, HCPCS, ASA, Modifiers adhering to CMS/AMA guidelines). Familiar with chart abstracting, what information is used, and how. Must possess a proficient understanding of anatomy, physiology, pathophysiology, disease process and medical terminology. Exemplary auditing skills that ensure coding quality and compliance. Ability to maneuver multiple computer applications including encoder, abstracting groupers, EMR and MS Office applications including Excel and Word required. Ability to coordinate work schedule with requirements of position (may include overtime and weekend work). Ability to work independently with minimal direct supervision seeking direction as needed. Thorough knowledge of coders role in revenue cycle operations, especially impact on Accounts Receivable (A/R). Critical thinking and problem solving skills required. Maintains patient confidentiality and information security. Ability to meet organizational goals and maintain accuracy rating as determined by Supervisor, Manager and/or Director with regular internal audits. Will be asked to adhere to department productivity standards.
Physical Demands and Work Environment
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. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.
Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.
