Reviews and validates outpatient clinical documentation and diagnostic results. Extracts data and assigns alpha numeric codes for billing, internal and external statistical reporting, research, regulatory compliance and reimbursement. Position Responsibilities: Applies 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 inclued Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material as required. Adheres to all department coding procedures, policies, guidelines and quality standards. Complete on a daily basis cases that have been assigned to them utilizing the appropriate work lists. Coding responsibility includes but is not limited to the following: Professional Primary Care Services Ancillary Services Gastrointestinal Undelivered/Labor & Delivery Cardiology Eye Center Life Star Home Health Hospice Home Heath coder conducts chart reviews using current version of OASIS. Assists manager with special projects/other tasks as assigned 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. Review claim edits and revise coding/charging as appropriate for specific range of ICD-10-CM/CPT/HCPCS codes. Review claims returned from various departments due to edits and process corrections for clean claim submission or post claim denial review for appeal. Seeks clarification from physicians or other staff in cases where documentation is absent, ambiguous, or contradictory Makes corrections based on collaboration with clinician or designee. This position reports to Outpatient Coding Manager
High School Diploma or GED is required. Associate Degree is preferred. Experience: Knowledge of anatomy and physiology, pathophysiology Zero to one year of progressive on-the-job experience in an acute care hospital, physician office or Home Health. Home health/hospice experience considered:Clinician with experience Prefer one to two years of progressive on-the-job experience in a hospital, OP Hospice, physician or Home Health setting Licensure, Certification, Registration:
CPC, CPCH, CCS, HCS-D and/or HCS-H certification required within 12 months from date of hire and maintained thereafter. Knowledge of: ICD 10-CM diagnostic and CPT/HCPCS procedure codes Working knowledge of clinical information Microsoft Office Products; Word, Excel Encoder and/or CAC Skills: Read, write and speak English proficiently. Solid analytical capabilities. Good organizational skills. Proficiently read and interpret physician writing. Ability to: Function independently. Handle multiple priorities. Listen and acknowledge ideas and expressions of others attentively. Converses 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
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Associated topics: clinical documentation specialist, collection, data entry, front, front desk, insurance, medical biller, medical transcriptionist, number, review