Medical Coder II-Coding Operations Medicine-Coding

Denials/Charge Review Accounts 

INTERNAL JOB DESCRIPTION -

Certified coding position supports coding denials and edits processing for Coding Operation - Medicine Team.

• Coding Denials Processing (40%) - Processes coding related edits that support defined specialty area(s)
  • Review of Denials Reason code to identify nature of denials.
  • Review and update coding of ICD-10-CM and CPT-4 as it pertains to Correct Coding Initiative (CCI), Local/National Coverage decisions (LCD/NCD) and other payer's specific edits and denials.
  • Sequence the diagnoses and procedures using coding guidelines.
  • Identification of denial trends to ensure charge capture and coding edits are prompted appropriately and that provider charge capture education material is created to ensure performance improvement of coding process.
  • Perform or initiate appropriate changes to patient account necessary to ensure appropriate coding and compliance w/ payer regulations to include the rebilling of appropriate claims. Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Charge Review Resolution (40%) -
  • Review of error reason to identify accuracy and nature of edit.
  • Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10 CM and/or CPT-4 coding conventions
  • Using coding expertise and available resources, arrive at a coding decision to clear/resolve error(s).
  • Implement coding decisions based upon current ICD-10 CM and CPT-4 guidelines, as well as payor and/or DUHS corporate compliance policies and procedures.
  • Document comments to support coding decision/action.
  • Manage WQ volumes, identifying any trends or unusual activity.
  • Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Customer Service (10%) - support Customer Service in response to patient inquires around coding issues
  • Review of inquiry.
  • Identification of coding related issue based on combination of inquiry, denials information and documentation of services performed.
  • Response to Customer Service including supporting notation to provide timely and appropriate response to patient.

• Denials/Edit Trending (10%) -review denial and edit/error  information for defined specialty area(s) and identify trends for overall process improvement

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position.

Employees may be directed to perform job-related tasks other than those specifically presented in this description.

Assist with research,  development  and presentation  of continuing education programs  on area(s) of specialization

Required Qualifications  at this Level

Education:                           

High school diploma required.

Experience: 

 CCS certification- one year of coding experience- Required

CPC certification- two years of coding experience -

Required ICD-10 Certification of Proficiency- Required

Degrees, Licensure, and/or Certification:

Must hold one of the following active/current certifications in addition to ICD-10 Proficiency Certification:

AHIMA Certified Coding Specialist (CCS/CCS-P) Hospital or PB Coding

AAPC Certified Professional Coder (CPC)