Job Summary:
Under direct supervision, the E&M/Specialty Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from appropriate documentation in the medical record, assigns codes and modifiers with ICD-CM, CPT and HCPCS Level II codes.
All work is performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines.
Essential Responsibilities:
- Review Medical Records to identify diagnoses/procedures.
- Under supervision, codes all diagnostic and operative information from the medical record using ICD-CM, CPT and HCPCS coding classification systems.
- Verifies and abstracts all medical data from the record to assign appropriate codes for the following settings: Inpatient Hospital (IP), Hospital Emergency (ED), Hospital observation (HOPS), Hospital Ambulatory (HAS) Hospital Outpatient (HOV) and Medical
- Office.
- E&M/Specialty Coder may require specialty coding and will remain part of the responsibilities as long as business dictates.
- Corrects data as appropriate.
- Review Medical Records to resolve Ingenix and HealthConnect Coding Edits.
- Under supervision, identify and resolve coding related edits by reviewing the medical record and ensuring that all data and codes are consistent with ICD-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, MediCal, USDOL, as well as KP Regional and Local policies.
- Corrects data as appropriate.
- Work Organization and Prioritization.
- Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved, in a timeframe that will assure compliance with regulatory, billing and SOX requirements.
- Completeness of Medical Record Data.
- Under general supervision, interacts with clinical contracts to clarify and promote accurate documentation of patient diagnostic and procedural information.
- Enters patient information into the computerized medical record and billing systems, ensuring the accuracy and integrity of the medical record data abstracted or encounter
- data corrected, prior to submitting the data.
- Ensures timely data completion by meeting coding/abstracting productivity/quality standards established for the E&M/Specialty Coder position in the current Coder Work At
- Home agreement.
- Provides feedback to monitor service provider and line of business compliance with regulatory requirements.
- Confidentiality / Security of Systems Maintains and complies with policies and procedures for confidentiality of all patient records.
- Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems.
- Other Duties: Answers the telephone promptly and identifies themselves and the department.
- Acts as a resource person to other departments regarding coding questions and issues.
- Performs other duties as assigned.
Grade: 594
Basic Qualifications:
Experience
- Minimum two years, within the last three years, certified professional coding experience.
Education
- High School Diploma or GED.
- Completion of classes in medical terminology, anatomy, physiology, current ICD CM and CPT coding conventions, and disease process from an accredited program is required.
License, Certification, Registration
- Certified Coding Specialist - Physician Based OR Certified Professional Coder OR Registered Health Information Technician
Additional Requirements:
- Achieve a minimum score of 80% on the E&M/Specialty Coder test.
- Basic knowledge of and use of computer keyboard
- Must be able to meet production and quality standards established for the position.
- Demonstrated knowledge of anatomy, physiology, medical terminology and disease processes.
- Demonstrated ability to understand the clinical content of a health record.
- Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing.
- Basic knowledge of reimbursement methodologies and conventions.
- Knowledge of rules and guidelines for current coding classifications.
- Practical knowledge of hospital and/or physician clinic based revenue cycle
- Practical knowledge of professional series coding and billing in a multi-specialty environment.
- Practical knowledge of government and other payer coding, billing and collection rules and regulations.
- Must maintain current coding credential and perform associated Continuing Education Units.
- Must abide by the AHIMA and/or AAPC code of ethics.
- Must be willing to work in a Labor Management Partnership environment.
Preferred Qualifications:
Pay Range: $45.97 - $48.78 / hour
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