Overview

The Clinical Coder is responsible and accountable for reviewing medical record documentation and assigning codes for reimbursement and statistical purposes.

Responsibilities

Dependent upon level of expertise defined in the Education/Training section:

Maintains a working knowledge of coding fundamentals: ICD-9-CM coding for inpatient, outpatient, and/or physician services; HCPCS coding, namely CPT-4 for surgical procedures, for outpatient and/or physician services; and/or HCPCS coding, namely Evaluation and Management, for physician services.

Maintains a working knowledge of coding guidelines: Official Guidelines for Coding and Reporting, American Hospital

Association’s Coding Clinics, and/or American Medical Association’s CPT Assistant.

Maintains a working knowledge of reimbursement as it relates to coding: the government prospective payment systems for inpatient, outpatient, and/or home health agencies, skilled nursing facilities, inpatient rehabilitation as well as other third party medical billing requirements.

Assigns codes based on medical record documentation and seeks further clarification from physicians when documentation is unclear, illegible, or conflicting. Achieves and maintains a high level of accuracy and productivity in coded claims.

Maintains a working knowledge of coding compliance.

Works in conjunction with the Business Office to reconcile denied claims due to coding issues.

Maintains a working knowledge of the HBOC and 3M system.

May perform some coding audits for quality checks.

May do some physician education.

Performs other related duties as assigned.

Qualifications

Dependent upon level of expertise defined in the Addendum: Must possess a minimum of two year coding experience. Certified Coding Specialist (CCS) approved by the American Health Information Management Association (AHIMA) for inpatient or hospital outpatient coding.

Bachelor or Associate degree and successful completion of the examination for Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) approved by AHIMA for inpatient or hospital outpatient coding.

Certified Procedural Coder- Hospital (CPC-H) approved by AAPC for hospital outpatient coding.

Certified Coding Specialist- Physician (CCS-P) approved by AHIMA for physician services coding.

Certified Procedural Coder (CPC) approved by the American Academy of Professional Coders (AAPC) for physician services coding.

Certified Coding Associate (CCA) approved by the American Health Information Management Association (AHIMA) for professionals new to the coding field. These individuals must seek further certification as a CCS, CPC-H, CCS-P, or CPC dependent upon their coping expertise within 5 years of date of hire.

All applicants for the Clinical Coder position must take and pass coding testsadministered by ARH prior to hiring. The coding test also consists of coding directly from sample patient charts.