Professional Coder II

Job Summary:

To collaborate as an intermediate level coder in the review of medical documentation provided by physicians and other health providers in order to obtain detailed information regarding disease, injuries, surgical operations, and other procedures and translate into alpha-numeric codes. To assign and sequence diagnostic and procedural codes as directed and in accordance with universally recognized coding systems.

Knowledge, Skills & Abilities:

Knowledge of electronic coding systems required. Knowledge of electronic health record. Knowledge of coding procedures and systems. Knowledge of medical terminology, anatomy and physiology. Competent knowledge in Microsoft Office Suite (Excel, PowerPoint, Word & Outlook). Excellent verbal and written communication skills. Ability to research coding questions and utilize UMMC’s internal educational resources. Independent, focused and able to work remotely and follow written instructions. Ability to use coding guidelines to assign correct codes with minimal supervision. Equipped to work remotely to include hardware with high speed internet via cable and Windows 10 or most up-to-date version.

RESPONSIBILITIES:

• Review medical documentation of intermediate complexity from physicians and qualified health professionals in order to assign diagnoses and procedures codes utilizing ICD-10 CM/PCS, CPT, or other recognized coding systems. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations.
• Ability to formulate complex query in order to obtain clarification of unspecified or incomplete documentation with physician or other qualified health professional, in order to accurately assign code assignment and communicates appropriate coding guidelines. Ability to determine when it is appropriate to escalate an issue to senior team member, provider or administrator.
• : Retrieves information from Electronic Health Record and enters abstracted information accurately into billing system. Maintains proficiency in quality and productivity standards.
• Reviews charges captured to support documentation of encounter and communicates discrepancies to department for resolution.
• Verifies information abstracted in coding and billing systems with documentation in medical record and updates as indicated. Resolves coding and billing edits as indicated by organizational policies and payer guidelines.
• Research coding and payer guidelines in order to resolve denials and optimize revenue.
• Conduct independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends.
• Collaborates with Coder III to review individual problematic cases and/or educational needs.
• Contribute to a positive working environment
• Maintains UMMC network security of personal health information of the medical record.
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Environmental and Physical Demands:

Requires no exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, frequent activities subject to significant volume changes of a seasonal/clinical nature, constant work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, occasional climbing, no crawling, occasional crouching/stooping, occasional driving, no kneeling,occasional pushing/pulling, frequent reaching, frequent sitting,frequent standing,occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Education & Experience:

High school diploma or GED required. 3+ year medical coding experience required. Experience in procedural & surgery coding preferred.

Certifications, Licenses or Registration Required:

One of the following certifications is required:

• Registered Health Information Management Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist- Physician-based (CCS-P)
• Certified Professional Coder (CPC)
• Any Physician Specialty certification from AAPC Radiology Coding Certification (RCC)