Hospital Based Coder I - Billing & Audit - FT - Days - MSS - Hybrid Eligible - Memorial Healthcare System
Miramar, FL
About the Job
Location:
Miramar, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.
Responsibilities:
Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Submits daily productivity report to HIM manager by defined deadline. Meets and maintains HIM coding quality and productivity standards. Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures. Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Researches medical record for any additional diagnoses documented to meet medical necessity.Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections, when advised, and follows procedure to notify billing.
Competencies:
ACCOUNTABILITY, ACCURACY (DRG), ACCURACY - CODER, ACCURACY - OUTPATIENT, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTH INFORMATION MANAGEMENT (HIM) SYSTEMS - CODER, HEALTH INFORMATION MNGMT, MEDICAL RECORD CODING, MEDICAL TERMINOLOGY (1), PRODUCTIVITY - IP CODING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK
Education and Certification Requirements:
High School Diploma or Equivalent (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures. Required Work Experience: For HIM coder, one (1) year hospital-based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System. Other Information: For HIM, Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA). For Physician Billing, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC. For Hospital Billing, Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC)
Working Conditions and Physical Requirements:
Miramar, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.
Responsibilities:
Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Submits daily productivity report to HIM manager by defined deadline. Meets and maintains HIM coding quality and productivity standards. Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures. Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Researches medical record for any additional diagnoses documented to meet medical necessity.Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections, when advised, and follows procedure to notify billing.
Competencies:
ACCOUNTABILITY, ACCURACY (DRG), ACCURACY - CODER, ACCURACY - OUTPATIENT, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTH INFORMATION MANAGEMENT (HIM) SYSTEMS - CODER, HEALTH INFORMATION MNGMT, MEDICAL RECORD CODING, MEDICAL TERMINOLOGY (1), PRODUCTIVITY - IP CODING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK
Education and Certification Requirements:
High School Diploma or Equivalent (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures. Required Work Experience: For HIM coder, one (1) year hospital-based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System. Other Information: For HIM, Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA). For Physician Billing, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC. For Hospital Billing, Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC)
Working Conditions and Physical Requirements:
- Bending and Stooping = 40%
- Climbing = 0%
- Ke
Source : Memorial Healthcare System
