Coder l, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

Under general supervision, analyzes patient medical records to assure that documentation by providers conforms to legal and procedural requirements. Assigns specified codes to medical diagnoses and/or clinical procedures. Interacts with physicians and other providers regarding billing and documentation policies and procedures. Audits medical charts and records for compliance with federal coding regulations and guidelines. Provides a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements.

POSITION EDUCATION/ QUALIFICATIONS :

• High School diploma/GED preferred

• RHIT or Medical certification program required

• Ability to read, write and speak English required

JOB KNOWLEDGE/EXPERIENCE :

• One (1) year experience required.

• Office coding experience is required

• Organizational skills are necessary

• Good written and verbal communication skills are required.

• Ability to communicate clearly and concisely with all levels of nursing, administration, and physicians

• Hospital or clinic experience preferred

• High degree of competency/experience in general Able to respond to patient needs by interpreting facial expressions and/or verbal communications.

• Requires reasoning ability and good independent judgment.

• Requires working with intermediate interruptions.

• Experience in medical records review/documentation requirements

• Experience in physician professional coding of E&M, and hospital surgery, procedures and professional modifiers

• Must project a professional image.

• High degree of competency/experience in general Able to respond to patient needs by interpreting facial expressions and/or verbal communications.

• Requires reasoning ability and good independent judgment.

• Requires working with frequent interruptions

Responsibilities:

POSITION RESPONSIBILITES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices

• Accurately Codes all diagnoses and procedures according to ICD-10-CM, CPT and APC guidelines

• Utilizes Coding Software including LCD and references.

• Meets quality standards of having 95% of charts coded accurately.

• Maintains a good working relationship within the department, other departments, and medical staff

• Codes assigned records in a timely a manner.

• Meets productivity standards set forth by Director/VP.

• Communicates with Director/VP to solve problems and to clarify coding issues.

• Reviews first level payor denials and assists with second level appeal.

• Works the queue on a daily basis for first level denied claims .

• Works in conjunction department staff on clearinghouse denials for cpt codes, diagnosis and modifiers.

• Attends workshops, seminars or conferences that pertain to position and that fulfill CE hours requirements.

• References updated ICD-10-CM, CPT, and HCPCS Level II code books or on-line resources as needed.

• Reviews Coding Clinic updates and continuing education periodicals in a timely manner.

• Adheres to the Health Information Management Policies and Procedures for Coding.

• Adheres to the Coding Compliance Plan.

• Follows the AHIMA Standards of Ethical Coding.

• Maintains confidentiality and safeguards all patient related information.

• Ability to handle pressure, meet deadlines, and remain productive in challenging situations.

• Performs other duties as assigned.

LINES OF REPSONSIBILITES :

(Chain-of-command)

1. Patient Accounting Supervisor 2. Director of Professional Revenue Cycle 3. VP of Revenue Cycle

4. Chief Ambulatory Officer

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA) :

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes : HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________