SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
DEPARTMENT: Health Information Management Department (HIM)
SUPERVISOR'S TITLE: Manager; Coding Services
TITLES SUPERVISED: N/A
TOTAL NUMBER OF FTE's DIRECTLY OR INDIRECTLY SUPERVISED: 0
PURPOSE OF POSITION: Provides support to the hospital ensuring accurate and timely coding and abstracting of medical records within a paperless environment utilizing a hybrid electronic medical record and electronic encoding product.
Reviews and screens the medical record to abstract designated statistical and clinical data and enters reliable information into 3M's Data Management System, Epic, and/or Fastrack, as appropriate. Assigns ICD-9-CM,ICD-10-CM/PCS, and/or CPT codes to accounts in an accurate and ethical manner utilizing 3M encoding software and coding manuals. Reviews encounters holding for additional documentation or other clarification on a regular basis in order to ensure completion of coding for timely billing. Meets or exceeds all established productivity standards. Submits completed coding activity logs in a timely manner. Effectively manages work responsibilities to meet deadlines, and departmental and organizational bill hold and AR goals.
Performs diagnosis and limited procedure coding with accurate implementation of ICD-9-CM,ICD-10-CM/PCS, and/or CPT coding guidelines. Uses available references to ensure compliant code assignment Meets or exceeds established quality standards.
Identifies and communicates to HIM coding management and/or the Data Quality team, gaps identified in clinical terminologies and medical vocabularies utilized in coding and abstracting processes, as compared to that which is present in the electronic health record documentation. Ensures coded data integrity by cross referencing information contained in all electronic patient information systems.
Provides meaningful and timely feedback in a professional manner to inner-departmental, organizational, and external customers, as appropriate. Participates in customer service initiatives.
Maintains currency of CMS, State of Ohio, official coding and other guidelines, rules and regulations, and applies principals as appropriate. Identifies and assumes responsibility for learning needs, and integrates new knowledge into practice. Successfully completes a minimum of 20 hours of continuing education every two years. Maintains currency in the field through continuing education, literature and seminars and maintains current credentials/licensure.
Using time efficiently and productively; prioritizing multiple tasks properly to meet deadlines; recognizing time constraints and adjusting work schedule to address them.
Understanding and showing respect and appreciation for the uniqueness of all individuals; leveraging differences in others' perspectives and ideas; appreciating cultural differences and adjusting one's approach to successfully integrate with others who are different from oneself
Basic understanding of hardware usage and troubleshooting
Ability to work autonomously, with independent judgment, as well as in a collaborative team environment.
Strong organizational and project management skills to handle projects independently.
Ability to independently work through details of a problem to reach a positive solution
Excellent verbal, written and/or interpersonal communication skills
Possess knowledge of ICD-9-CM, CPT-4, ICD-10-CM, and ICD-10-PCS coding systems and guidelines. Knowledgeable in CMS, Ohio Medicaid, and other regulatory agency rules and regulations related to coding and reimbursement.
Working knowledge of basic computer applications such as Microsoft Office, email and internet.
Basic review of data, work queues, and reports.