Coder II: Medical Coding

Description

Primary Duties And Responsibilities

The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines.

Verify that all ICD-10-CM codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings.

Performs other duties as assigned. Medical Coding - Hoag Hospital

In addition to the above, the coder resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity and quality standard of 95% accuracy rate or better. Identifies chargeable items and facility level for emergency department visits.

Additionally, the Coder II assigns codes for diagnoses, treatment, and procedures for Outpatient Procedures. The Medical Coding department also assigns codes for the Emergency Department and identifies chargeable items and facility level for emergency department visits, including observation services.

Claims – Coder II coders may assist the Fiscal Coder or Biller with working the front end or backend edits on accounts that require a coder to review. Works with Fiscal Coder or Revenue Cycle Team to review correct coding and/or modifier assignment.

May work remotely if minimum technology requirements, productivity and quality requirements are met and the Telecommuter Work Agreement is signed and adhered to. Coding - Hoag Clinic

In addition to the above, the coder meets ongoing productivity and quality standard of 95% accuracy rate or better. The coder follows all coding conventions and serves as a coding consultant to Hoag providers. Discrepancies are identified that may impact quality of care and/or billing issues. The coder will serve as a resource and subject matter expert to other coding staff.

Completes coding charge review and claim edits in Epic or other appropriate EMR system which would entail coding and correcting ICD-10 codes, modifiers, CPT, E/M, and procedure codes.

Qualifications

Education and Experience

High school diploma or equivalent required.

Medical Coding - Hoag Hospital:

Completion of a certified coding program or graduate of a CAHIM accredited HIT program required.

Two years (2) of hospital acute care Emergency and/or Outpatient procedures, and same day surgery.

Coding - Hoag Clinic:

Required: Minimum 2+ years of work experience as a medical coder.

Preferred: Coding experience in multiple specialties to include but are not limited to: OB/GYN, Urology, Oncology, Pain Management, Cardiology, General Surgery, Cardiothoracic, Neurosurgery, Neurology, and Orthopedics procedures. Knowledge of E/M coding.

HASCH – 2 years’ experience required.

Graduate of a CAHIM accredited HIT program and is CCS eligible or RHIT eligible preferred.

Spine and Ophthalmology experience preferred

License Required:

N/A

License Preferred:

Certifications Required

Medical Coding - Hoag Hospital: Certified Coding Specialist (CCS)

Coding - Hoag Clinic: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist Physician-Based (CCS-P), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA)

Home Health: Home Care Coding Specialist (HCS-D), or Certified Coding Specialist (CCS), or Certified Professional Coder Certification (CPC)

HASCH Administration: Certified Coding Specialist – Physician based (CCS-P) or Certified Professional Coder Certification (CPC) or Certified Outpatient Coder (COC)

Cath Lab/IR: Certified Coding Specialist (CCS) or Certified Interventional Radiology Cardiovascular Coder (CIRCC)

Certifications Preferred

Coding - Hoag Clinic: Certified Urology Coder (CUC)