Job Description
Job Description
Summary
Responsible for applying appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis, and claims processing.
Qualification Requirements
Must be proficient in most current CPT, ICD coding, medical terminology, anatomy, and physiology. Required basic knowledge of medical procedures and disease states/processes.
Minimum Qualifications
- RHIA, CCS, or CPC certification and 2 years of coding experience using ICD-10-CM, CPT, and HCPCS.
- May substitute certification with 4+ years of recent, directly related coding experience in a medical office or specialty care setting using ICD-10-CM, CPT, and HCPCS.
- High school diploma or GED required.
- Experience with EHR systems, claims processing, and payer documentation standards strongly preferred.
- Prior work in nephrology or other outpatient specialty practice is a plus.
Knowledge, Skills and Abilities
- Detail oriented and excellent records maintenance skills.
- Ability to communicate effectively both orally and written.
- Proactive individuals with the ability to be a self-starter with strong independent decision-making skills and attention to detail.
- Ability to foster a cooperative work environment. Possess a willingness to accept orders and to perform repetitive tasks.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Knowledge of healthcare billing procedures, documentation, and standards.
- Ability to make evaluative judgments.
- Skill in the use of personal computers and related software applications to include word processing.
- Ability to function well while involved in multiple task assignments. Skill in organizing resources and establishing priorities.
- Knowledge of operational characteristics and procedural requirements of third-party medical insurance payors.
- Ability to analyze medical records and identify billable services.
- Understand the ethics of confidentiality and the ability to maintain confidentiality of sensitive information.
- Special ability to communicate well with physicians, staff, and public.
- Working knowledge of Microsoft Word, Excel, and Outlook. Above average understanding and proficiency using word processing and spreadsheets.
- Computer skills also include knowledge of applicable EHR, Practice Management, and Document Manager systems.
- Excellent oral and written communication skills required.
Supervisory Responsibilities: None
Essential Functions
- Properly assign and sequence ICD-10-CM, CPT and HCPCS codes to all patient diagnoses and procedures based on medical record documentation 25%
- Audit patient records for coding compliance, verification of services rendered, and medical necessity when necessary. 25%
- Identify, clarify, and/or correct coding issues such as lack of specificity, missing or incorrect modifiers, missing services, bundling/unbundling 25%
- Keep abreast of coding guidelines and reimbursement reporting requirements. Bring identified concerns to the Medical Coding Supervisor 5%
- Perform related work as required to accomplish the mission of the organization. Assists in data entry of monthly capitation charges if needed. 10%
- Audit patient records for coding compliance, verification of services rendered, and medical necessity when necessary. 10%
Physical Demands
- Hearing, visual acuity, talking.
- Reaching, grabbing, holding – fine motor skills.
- Extended periods in a stationary or standing position.
- Repetitive motion such as entering data into computer-based programs.
- Lift or move up to 10 pounds. Employees are expected to use appropriate ergonomics and tools such as hand carts for heavier loads.
Work Environment
Work is normally performed in a typical interior office environment. The noise level is usually moderate.
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of the position. All employees may have other duties assigned at any time.