Medical Coder I
FLSA Status: Non - Exempt
Location: LACKLAND AFB/Randolph
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
The primary duties of a Medical Coder I are to review clinical documentation and assign medical codes for outpatient clinic facility and/or professional services.
Essential Functions of the Position:
While meeting the timeliness standards, productivity standards and accuracy standards established by the Air Force and or the Military Health System (MHS) :
1.Accurately assign diagnosis, procedure, and supply codes for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters. Codes assigned include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers. Use military computer systems to assign, edit, and review codes. Apply knowledge of medical terminology, anatomy and physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection. Adhere to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management code to ensure ethical, accurate, and complete coding. Monitor ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided.
2.Review encounter and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal re-percussions or impacts quality patient care. Identify any problems with legibility, abbreviations, etc., and bring to the provider’s attention. Examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained. Develop and submit a written (electronic or hard copy) query IAW AFMS guidelines to the provider to request clarification of provider documentation that is conflicting, ambiguous, or incomplete in regards to any significant reportable condition or procedure. Work with providers to resolve documentation issues to support coding compliance. Assign accurate codes to encounters based upon provider responses to queries and reports queries and responses IAW AFMS guidance.
3.Act as a source of reference to medical staff having questions, issues, or concerns related to coding. Respond to provider questions and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Based on contacts with the medical staff, identify training opportunities and work with coding training personnel to focus on consistency and clarity of coding advice provided. May assist medical training specialist with providing initial coding training to providers by providing guidance to professional and technical staff in documentation requirements for coding.
4.Support AFMS coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the Government supervisor, or Service coding representatives. May perform focused audits of specific MTFs, medical specialties, clinics, coders, or providers as directed and IAW AFMS audit procedures. Perform administrative related tasks associated with medical records final reviews/audits and contacting various departments, services, or medical staff to obtain data needed to complete the records. Maintain confidentiality and privacy of medical, personal, and sensitive information in compliance with the Health Insurance Portability and Accountability Act. Comply with AFMS coding compliance requirements regarding training and reporting of potential violations.
5.Correct all write-back errors caused by coding errors. System Edit Error Correction: the entry and transmittal of patient and coding data through different Government computer systems will sometimes be flagged for errors (known as “write-back errors”). Write-back errors are corrected by the MTF staff or coders and tracked through corrective action. Write-back errors generated by a patient administration error (for example, incorrect or missing demographic information) is corrected by the MTF Patient Administration section.
6.Assist the AFMS MCPO in monitoring coding compliance through performing audits of AFMS coders in a double blind audit method IAW AFMS MCPO guidelines, rules, and standards; and performing focused audits of AFMS MTFs, specialties, clinics, or providers IAW AFMS MCPO guidelines, rules, and standards. This involves accurately analyzing diagnosis, procedure, and supply codes for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters. The codes assigned include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers.
7.Exercise independent and objective judgment in assigning errors, providing a rational and citing official guidelines, policies, regulations, rules, or standards as reference for assignment of errors.
8.Professionally interact with MTF staff and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations. Obtain clarification of conflicting, ambiguous, or non-specific documentation. Provide advice, assistance, and technical support to MTF staff, Medical Coders, reviewers, Medical Coding Compliance Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.
Education and Experience:
Education: An associate’s degree in Health Information Management; or at least 30 semester hours’ university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology, or successful completion of an AAPC or AHIMA coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology.
Credential: Must have at least one: RHIT; RHIA; CPMA; CPC; COC; or CCS-P. Continuing Education Requirements: must maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position.
Experience: Mini 4 years of medical coding and experience in 2 or more medical or surgical specialties within the past 8 years, OR 3 years’ outpatient coding experience within the last 6 years in a military coding environment. A minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Additionally, coding exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.
Must pass a pre-employment coding test.
Proof of immunizations is required.
MUST obtain a government security clearance.
Mandatory Knowledge and Skills
a) Practical knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
b) Practical knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
c) Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
d) Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management.
•Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions
•Receive, attend to, interpret, and respond to verbal messages and other cues such as body language in ways that are appropriate to listeners and situations.
•Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
•Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
•Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information (for example, facts, ideas, or messages) in a succinct and organized manner; produce written information, which may include technical material, that is appropriate for the intended audience.
•Display, courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations
•Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
•Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
•Be open to change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.
•A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.
•Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations
•Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud
•Use imagination to develop new insights into situations and apply new solutions to problems; assist in designing new methods where established methods and procedures are not suitable or are unavailable.
Works under the general supervision of the LEAD and or Program Manager or his or her designee.
RESPONSIBILITY FOR PUBLIC CONTACT
Daily contact with diverse audience requiring courtesy, discretion, and sound judgment.
LICENSING AND CERTIFICATION
RHIT; RHIA; CPMA; CPC; COC; or CCS-P certification is required.
TOOLS AND EQUIPMENT USED
Coding books, computer, phone, fax, scanner, printer, various software packages, internet and other office equipment.
The work is primarily sedentary.
•The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•While performing the duties of this job, the employee is frequently required to sit, talk and hear; use hands and fingers to operate, handle, or feel objects, tools, or controls; and reach with hands and arms.
•Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records or documentation may be required daily.
•Specific vision abilities required by this job include close vision and the ability to adjust focus.
•The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•The noise level in the work environment is usually moderately quiet.
•The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
Review medical record and assigns code based on documentation. May contact providers and or other medical staff to obtain information and or to clarify documentation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Employee signature below constitutes employee's understanding of the requirements, essential functions and duties of the position.