Overview

Job Summary:

Demonstrates through behavior Decatur Morgan Hospital’s mission, vision and values.

The Certified Professional Coder is responsible for accurate coding assignments of services performed in a medical office setting, hospital setting or outpatient surgical setting for physician and non-physician providers professional fees. Based upon the provider documentation as well as other supporting clinical documentation/reports where acceptable and appropriate the coder using their training, expertise and software tools will assign/confirm diagnoses and procedures as indicated in the patient medical record. Classification systems include Current ICD-10-CM and current CPT edition, current HCPCS Level II and all coding is in accordance with official coding guidelines from the American Medical Association and AAPC – Codify All work is carried out in accordance with the Decatur Morgan approved policies and procedures.

Responsibilities

Key Responsibilities / Essential Functions

1. Review appropriate provider documentation to determine principal diagnosis, conditions and surgical procedures.

2. Assign ICD-10-CM diagnosis and procedure codes for Medicare and non- Medicare patient encounters.

3. Assign ICD-10-CM diagnosis codes and CPT procedure codes for outpatient procedures and surgery encounters.

4. Assign diagnosis and procedure codes in the correct sequence.

5. Utilize technical coding principals and reimbursement expertise to assign appropriate ICD-10-CM diagnoses and procedures.

6. Work Alpha II edits as assigned facilitating billing corrections

7. Assign correct discharge disposition to all hospital inpatient or observation encounters

8. Compile report of incomplete records and monitor pending charge report.

9. Compile special reports as requested.

10. Coordinate internally with PBO team on billing/coding issues.

11. Communicate with physicians to ensure complete, correct medical record documentation.

12. Process codes and accounts according to the 2- 3-day rule.

13. Assist with recovery audit contractor (RAC) audits.

14. Review denied claims and assist with appeal letters as may be necessary.

15. Assist in correct assignment of charge description master codes.

16. Provide assistance for physician review of records.

17. Remain current on coding clinic advice.

18. Remain current on CPT assistant advice.

19. Assist with medical necessity reviews as needed.

20. Meet coding standards of productivity established by Decatur Morgan EPN.

21. Demonstrate a high degree of accuracy and attention to detail at all times.

22. Collect and analyze special project data.

23. Provide accurate and timely information using discretion and protect confidentiality of information.

24. Use policy and procedure manuals, and other reference materials, to ensure proper course of action in daily business operations. Coding reference material utilizing AAPC software efficiently and AMA coding guides.

25. Maintain a cost-conscious attitude to time usage, materials, and supplies.

26. Maintain equipment in proper working order.

27. Perform additional duties as assigned.

Qualifications

Minimum Knowledge, Skills, Experience Required:

Education: High School Diploma, GED required. Must have minimum of CPC (Certified Professional Coder) Certification . Additional coder certifications desirable.

Experience: Must possess in-depth knowledge of medical and anatomical terminology, reimbursement principles, EMR, sequencing of diagnoses, and the use of coding software. Prefer a minimum of 1 or more years of active coding within a medical office setting preferably multi-specialty, surgical, OB/GYN other specialties a plus. Ability to communicate fluently with physician and non-physician care providers to question and provide guidance to ensure coding accuracy and compliance. Ability to interact with billing specialists understanding the impact of proper coding on reimbursement and denials.