Essential Job Functions

• Reviews documentation in records and accurately assigns diagnosis codes.
• Sequences diagnosis codes following CMS, AHIMA, AHA, and AMA guidelines.
• Queries professional staff when necessary to clarify ambiguous documentation for correct code assignment.
• Keeps abreast of coding guidelines and reimbursement reporting requirements.
• Brings identified concerns to Manager/Director or Compliance Officer for resolution.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and/or American Academy of Professional Coders and adheres to official coding guidelines.
• Provides feedback and education to physician and professional staff regarding coding and documentation quality.
• Receives customers and/or answers telephone courteously, determines need, and responds appropriately.
• Submits productivity sheets, as required.
• Performs timely follow-up on all claims rejected for medical necessity issues.
• Monitors LMRP bulletins for changes to medical necessity coverage issues.
• Monitors SHP reports, faxes to assure software is running properly. Reports problems to Home Health Management.
• All required data is verified and accurately entered into the EMR.
• Performs follow-up necessary to assure timely coding completion.
• Provides coding support and guidance to newer coding staff.
• Analyzes and interprets medical records for assignment of specific codes to ensure a comprehensive, accurate, and optimal coding profile of Home Health and Hospice accounts.
• Abstracts patient clinical data via the Home Health EMR and verifies that accounts successfully pass coding edits.
• Maintains an accuracy rate of 95%.
• Participates in case analyses and assists Case Managers with accurate code selection.
• Other duties as assigned.

Competency and Experience [Knowledge, Skills and Abilities]

Required Qualifications/Experience

• High School Diploma, GED, or higher level of education.
• Successful completion of a Coding Certificate Program with concentration on ICD-10/CPT-4, Anatomy & Physiology and Medical Terminology coursework.
• Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
• Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.

Preferred Qualifications/Experience

• Associate’s or Bachelor’s Degree in Health Administration or Related Field
• 1 to 3 years’ experience in Medical Coding.
• Experience in Healthcare setting.

License, Certification & Clearances

• Act 34-PA Criminal Record Check from the PA State Police system

Work Environment (please list work environment i.e.: temperature, noise level, other factors that will affect the working conditions while performing the job)

Position Type/Expected Hours of Work

• Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
• Travel may be expected locally between System locations.

Physical Demands/Requirements (please list the physical demands of the job)

Equal Employment Opportunity

Independence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations.

Disclaimer

This job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Work Environment

Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines

Physical Demands