Evaluate patients records, work to resolve inaccurate charges, and assign appropriate diagnoses & procedure codes using the coding systems according to HIPPA regulations. Abstract pertinent data from patients' clinical records. Review records for reimbursement purposes and to ensure quality control.

Responsibilities

• Read and interpret ambulatory surgery or observation or outpatient or inpatient medical record entries to identify all diagnoses and surgical procedures. • Assign appropriate ICD-9-CM/ICD-10 and CPT-4 codes in compliance with recognized coding principles and department policies. • Determine appropriate diagnostic and procedural sequencing in compliance with UHDDS guidelines. • Effectively utilize the APCpro features of 3M with the 3M encoder and grouper software to identify appropriate assign modifiers, make appropriate changes to charges, notify departments to make changes, identify missing documentation, and prepare the account as a clean claim for billing to the third party payer. • For inpatient accounts, effectively utilize the APR-DRG and MS-DRG features of 3M with the 3M encoder and grouper software to appropriately assign Present on Admission indicator, Risk of Mortality score, Severity of Illness score, identify missing documentation and work with Clinical Documentation Specialists to resolve documentation deficiencies. • Utilize the 3M encoder and grouper for DRG assignment for inpatient records and the APC Grouper for APC assignments for outpatient records. • Responsible for the accurate and timely entry of all abstracted and coded date into the computer system. • Comply with HCFA's Medicare code edits. • Ensure quality and accuracy of records for appropriate reimbursement. • Verify and correct any data discrepancies by initiating communication with physicians and other hospital personnel. • Guide physicians in recording and sequencing final diagnoses. • Provide one-to-one physician consultation regarding diagnostic sequencing, specificity and grouper concepts. • Assist with physician education regarding the requirements of the Prospective Payment System. • Assist with improving record documentation practices to support DRG assignments. • Promote and enhance positive customer service and a positive work environment. • Assist with Coding Review Request. • Work Denial related Queues in revenue cycle to assure appropriate approval. • Trouble shoot and analyze front end build issues impacting edits and denials from a coding perspective. • Work with Patient accounts closely to monitor denials and provide a team effort in resolution.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• High School Diploma or GED (Required) Experience: 3 years related

Credentials

Work Schedule: Days

Status: Full Time Regular

Location: General Hospital

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Chet A. Harless chet.harless@vandaliahealth.org