What are the responsibilities and job description for the Pro-Fee Coder position at West River Health Services?
Position Summary:
Conducts necessary audits of medical record to verify that providers have appropriately documented chronic medical conditions, then code these in ICD-10 to capture HCCs and improve the organization’s Medicare Risk Adjustments score. Evaluate medical record documentation (outpatient/inpatient) from a clinical standpoint for evidence of the possibility of additional medical conditions that may not have been documented in the past. This process involves a very strong understanding of medical coding and excellent communication skills.
Excellence in Practice:
Education: Two-year health information technician. The physician coder must possess a thorough working knowledge of current nomenclature coding systems, i.e. ICD-10 and CPT
Experience: A minimum of three to five years of experience in a clinical setting.
License Requirements: RHIT, CCS, CCS-P, and/ or CPC are required
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Conducts necessary audits of medical record to verify that providers have appropriately documented chronic medical conditions, then code these in ICD-10 to capture HCCs and improve the organization’s Medicare Risk Adjustments score. Evaluate medical record documentation (outpatient/inpatient) from a clinical standpoint for evidence of the possibility of additional medical conditions that may not have been documented in the past. This process involves a very strong understanding of medical coding and excellent communication skills.
Excellence in Practice:
- Abstracts pertinent information from patient medical records, assigning appropriate ICD-10-CM codes, creating HCC assignments as applicable.
- Check chart assignments every day and report accurately all hours worked on a weekly basis
- Remain current on medical coding guidelines and reimbursement reporting requirements
- Queries when documentation in record is inadequate, ambiguous or otherwise unclear for medical coding purposes.
- Provide Education – Provide detailed summary to make adjustments to correct improperly paid claims and document the correct coding to be utilized
- Prepare management summary report of audit findings
- Comply with the Standards of Ethical Coding as set forth by the AHIMA (American Health Information Management Association) and adhere to official coding guidelines
- Comply with HIPAA laws and regulations
Education: Two-year health information technician. The physician coder must possess a thorough working knowledge of current nomenclature coding systems, i.e. ICD-10 and CPT
Experience: A minimum of three to five years of experience in a clinical setting.
License Requirements: RHIT, CCS, CCS-P, and/ or CPC are required
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