Coder II - MPG - Hybrid: MPG - Business Office

Summary: Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.
Detailed responsibilities: • Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments.
Reviews coding edits.
Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity.
Research electronic medical record for any additional diagnoses documented to meet medical necessity.
Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements.
Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to admission.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
Create electronic physicians queries within allowed scope for hospital outpatient coder.
• Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures.
Conducts, audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing.
• For hospital encounters, 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.
Reviews chargemaster generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors.
Makes appropriate coding corrections when advised and follows procedure to notify billing.
For Professional Billing, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing.
• Communicates with insurance companies about coding errors and disputes for physician billing.
Reviews and validates accuracy of data in Admission-Discharge-Transfer (ADT) fields following HIM coding policies and procedures.
Reviews CRW (Certified Social Worker) documentation to assign correct discharge disposition, notify coding management when clarification needed.
• Adjusts and adapts to continual changes in the coding field.
Practices ethical coding per AHIMA Standards of Ethical Coding.
Meets and maintains HIM coding quality and productivity standards.
Submits daily productivity report to HIM manager by defined deadline.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
• Enhances and maintains coding knowledge and skills for physician billing.
Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.
Competencies and skills: Essential: • STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
• CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
• ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback.
Connects personal work results to the accomplishment of team and organizational goals.
• RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence.
Views new assignments and job responsibilities as an opportunity for growth.
Education: Essential: • High School Diploma or Equivalent Credentials: Essential: • Coding Certification Education equivalent experience: Essential: • For HIM, completion of coding training program.
Other 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 including Microsoft Office applications, computerized encoder, and electronic medical record systems.
Ability to perform job duties using an electronic medical record system.
Requires a strong proficiency and understanding of Medical Terminology, Anatomy & Physiology, Pathophysiology and Pharmacology.
Knowledge of coding classification systems and procedures.
Possesses a strong foundation in coding and clinical knowledge with ability to review, research and code diagnoses and procedures with a high level of complexity.
Required Work Experience: For HIM coder, two (2) years hospital-based outpatient coding experience or a graduate of the internal MHS Coder Intern Program.
For Physician Billing coder, two (2) years of higher complexities of diagnostic/procedural/office coding experience.
For Physician Billing coder, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC.
For HIM, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS).
For Physician Billing, Certified For Physician Billing, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC.
Working conditions: Essential: • Bending and Stooping 40.
00% • Keyboard Entry 60.
00% • Kneeling 40.
00% • Lifting or Carrying 0 - 25 lbs Non-Patient 40.
00% • Pushing or Pulling 0 - 25 lbs Non-Patient 40.
00% • Reaching 40.
00% • Repetitive Movement Hand/Arm 60.
00% • Sitting 60.
00% • Squatting 40.
00% • Standing 60.
00% • Walking 60.
00% • Audible Speech 80.
00% • Hearing Acuity 80.
00% • Depth Perception 60.
00% • Distinguish Color 60.
00% • Seeing - Far 60.
00% • Seeing - Near 60.
00% • Computer Monitor 80.
00% Organizational Profile: Memorial Healthcare System, consisting of 6 acute care hospitals, a nursing home, outpatient facilities, home health services and physician practices, provides quality, comprehensive care to the residents of the surrounding communities.
We invite you to join one of the nation's leading healthcare systems, recognized for use of advanced technology and clinical informatics.
Memorial Support Services provides a variety of business services to support our facilities.
The main offices are located in Miramar with satellite offices located throughout our system.
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job.
It is intended to indicate the general nature and level of work performed by employees within this classification.