Job Summary: The coding specialist performs highly technical and specialized functions for the medical, dental, behavioral health and outreach departments at Pit River Health Service. This position of coding specialist reviews, analyzes, codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments.
The primary function of a Coding Specialist is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement. The Coding Specialists’ function is a primary source of data used in promoting provider/patient continuity, accurate database information, and the ability to optimize reimbursement. In addition, enter data from outside providers and assist the Billing Specialist.
The Coding Specialist position ensures compliance with established coding regulations and guidelines.
Specific duties and responsibilities:
1. The Coding Specialist will maintain the highest integrity in patient confidentiality, safety and security, abiding by and complying with all HIPAA regulations. Maintain confidentiality, security and safety of patient records.
2. Coding Specialists assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented patient visits and assures the final diagnosis codes and operative procedure codes as stated by the physician are valid and complete. Coding Specialist will insert correct codes as needed based on provider notes. If notes are unclear, Coding Specialist will communicate with provider for clarity.
3. Coding Specialists abstract all necessary information and assigns codes (ICD-10, CPT & HCPCS), which most accurately describe each documented diagnosis, special therapy or procedure according to established guidelines; in addition to identifying secondary complications and co-morbid conditions.
4. The Coding Specialist assures the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
5. Quantitative analysis – Coding Specialists perform comprehensive review of provider documentation to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
6. Qualitative analysis – Coding Specialists evaluate the record for documentation consistency and adequacy; ensuring that the final coding accurately reflects the care and treatment rendered.
7. The Coding Specialist analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code.
8. Operates RPMS for the purpose of key-entering data - for the process of updating or changing health summaries for patient information files and of exporting said data to the billing department.
9. Establish and maintain a log for providers who have outstanding accounts with chart deficiencies.
10. Coding Specialists perform all duties according to established safety procedures, PRHS policy and other duties that may be assigned by the business office manager.
11. Enter patient information into the RPMS systems if needed from reports received from outside providers (e.g. Labs, radiology, operations/surgeries).
12. In addition, assist the Billing Specialist in the process of medical, dental and other insurance billing and assist with any follow-up on claims unpaid that are 90 days and older.
13. Reporting Incidents-refer to policy and procedures.
14. All other job duties as assigned by supervisor.
Qualifications:
1. Completion of high school, or equivalent.
2. Two years of coding experience using ICD-10-CM or equivalency.
3. CCS, CCS-P or CPC certification is required and the incumbent is expected to obtain CPC certification (Certified Professional Coder) and to enroll in continuing education courses to maintain that certification.
4. If certification is lacking it must be obtained within six months of hire. The Supervisor may make a recommendation for an extension.
Job Knowledge:
1. Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record.
2. Knowledge of medical codes with ability to select the of most accurate codes using the ICD-10-CM, CPT, HCPCS, and IHS coding conventions.
3. Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-10-CM code.
4. Knowledge of medical codes involving selection of most accurate and descriptive code using the CPT codes for billing of third-party resources.
5. Knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
6. Knowledge of RPMS and IHS Electronic Health Record is desired in order to analyze encounters and notify providers of data that needs corrections through EHR broadcasts, notifications and templates.
7. Must have good math skills and effective communication skills.
8. Must be knowledgeable of the fiscal requirements, policies, and procedures of federal, state, and tribal programs.
9. Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data.
10. Requires skill in the use of a wide variety of office equipment including: computer, fax, calculator, fax, copy machine, and other office equipment as required.
11. Must be customer service oriented.
12. Ability to cross train within the department.
13. Must be able to follow instructions and work independently.
14. Possess a valid CPR Card
15. Preference will be given to Native Americans in accordance with P.L. 93-638.
16. Must be willing to submit to and pass a pre-employment drug screening test and physical clearance.
Pay: $19.52 - $28.29 per hour
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
