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Responsible for reviewing patient medical records after a visit and translating the information into codes that insurers use to process claims from patients. Duties include confirming treatments with medical staff, identifying missing information and submitting information to insurers for reimbursement.
Principal Duties and Responsibilities:
*Analyzes medical information documented in patient medical record and codes all relevant diagnoses and procedures accurately using the appropriate code set (ICD-10-CM, ICD-10-PCS,) according to the correct classification system for the inpatient encounters.
*Performs coding and related duties of very moderate/highly complex accounts using established policies and procedures in an accurate and timely manner. Applies and follows official Coding Guidelines, AHIMA standards of ethical Coding and facility/department specific policies and procedures. (May occasionally code highly complex or moderate complexity inpatient accounts as needed or requested by Senior Manager).
*Research, understand, and interpret complex coding and/or billing rules and regulations for new and/or existing diagnoses or procedures.
*Ability to explain critical thought processes and justification for highly complex coding and/or DRG scenarios to internal and external stakeholders, including physicians, clinical staff, Coding, CDI, Quality and other professionals and leadership.
*Demonstrates understanding of the Prospective Payment System methodologies (groupers, encoders, MS-DRG, APR-DRG, APC, PPS (Prospective Payment System), and payor specific methodologies as it applies to the coding classification for the encounter.
*Demonstrates commitment to integrating coding guidance and compliance standards into daily coding practices. Identify, correct and report coding related problems according to procedure.
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member.
Education
High School Diploma or Equivalent required
Associate's Degree Finance preferred
Licenses and Credentials
AHIMA Certification
CCS Certification is required
Certifications may include RHIT, RHIA, CCS (strongly preferred)
Must have a minimum of 2 years of experience.
Experience
2 + years of medical coding experience
Knowledge, Skills and Abilities
Proficiency in ICD-10-CM, ICD-10-PCS, MS-DRG; APR-DRG and Coding Clinic
Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
Proficient with computer applications (MS Office etc.), Excellent data entry skills.
Coding Specialist • Somerville, MA, United States
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