The Coding Analyst reports to the Manager of Coding and will demonstrate expertise in the coding and analysis of pediatric medical records. The Coding Analyst is responsible to review, analyze, and code diagnostic and procedural information for technical or professional services that determine the care and treatment provided to the patient. The primary function of this position is to perform ICD-10-CM, CPT, ICD-10-PCS (IP tech / DRG) and HCPCS coding for Medicare, Medicaid and private insurance payments. The coding function will ensure compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
Qualifications : Minimum Education
High School Diploma or GED (Required) And
Associate's Degree (Preferred)
Minimum Work Experience
1 year Hospital-based coding experience required; pediatric experience preferred. (Required)
Functional Accountabilities
Productivity and Accuracy
- Assign and sequence ICD-10-CM / CPT / HCPCS / ICD-10-PCS (IP tech / DRG) codes to diagnosis and operative procedures for documented information; assure the final diagnosis and operative procedures as stated by the physician are valid and complete; abstract all necessary information from health records to identify secondary complications and co-morbid conditions.
- Meet department accuracy and productivity standards for coding, abstracting, and record reconciliation activities.
- Abstract all necessary information and assign codes ICD-10-CM / CPT / HCPCS / ICD-10-PCS (IP tech / DRG) , which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines
Billing Documentation
Identify services needing to be abstracted / coded by following prescribed procedures for the capture of inpatient and outpatient services; this may involve the use of admissions, transfer and discharge reports, appointment schedules, and / or surgical schedules.Abstract applicable clinical documentation (e.g. admit report, consultation report, progress note, surgical report, etc...) for purpose of determining the appropriate billing information (e.g. provider name, date of service, CPT code, ICD-10 code, modifier(s), etc...).Ensure that all documented services are captured and coded and that all coding work is performed in a manner consistent with applicable coding rules and conventions.Verification
Perform a comprehensive review of the record 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.Analyze provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code.Evaluate the record for documentation consistency and adequacy; ensure the final diagnosis accurately reflect the care and treatment rendered; review the records for compliance with established third party reimbursement agencies and special screening criteria.Determine the final diagnosis and procedures stated by the physician or other health care providers are valid and complete.Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment / Identification
Anticipate and responds to customer needs; follows up until needs are metTeamwork / Communication
Demonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement / Problem-solving
Contribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management / Financial Responsibility
Use resources efficientlySearch for less costly ways of doing thingsSafety
Speak up when team members appear to exhibit unsafe behavior or performanceContinuously validate and verify information needed for decision making or documentationStop in the face of uncertainty and takes time to resolve the situationDemonstrate accurate, clear and timely verbal and written communicationActively promote safety for patients, families, visitors and co-workersAttend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
