Position Details

Work Shift :

Day Shift (United States of America)

Scheduled Weekly Hours :

Department :

Health Information Management

Overview of Position :

The employee reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments.

The incumbent performs ICD-10, CPT and HCPCS coding for reimbursement. The incumbent must ensure accuracy to help provide correct information to various third-party payors allowing for maximum allowable reimbursement for services.

Must adhere to and comply with established coding guidelines, policies, regulations and accreditation standards.

ESSENTIAL DUTIES

1. Optimizes reimbursement, which Genesis HealthCare System is legally entitled, by applying effective coding strategies.

2. Reviews and applies coding and reimbursement resources in a timely manner to ensure an up to date knowledge base.

3. Consistently applies coding and reimbursement rules to ensure appropriate coding of same day surgeries, observations, and inpatient accounts.

4. Maintains discharged not final billed (DNFB) accounts for ED, pain, OB, and / or infusions.

5. Reviews record for equipment and supplies above named department procedures.

6. Applies CPT code to reflect clinical services provided.

7. Works closely with clinical personnel to ensure all chargeable items are correctly documented entered on every encounter.

8. Abides by the Standards of Ethical Coding as set forth by AHIMA and adheres to Official Coding Guidelines.

9. Abides by rules and regulation of Medicare billing including consultations and Global Surgery.

10. Identifies and reports inappropriate coding practices.

11. Assigns and reports codes that are clearly and consistently supported by physician documentation in the health record.

12. Discerns clinical notes, uses skills, and knowledge of currently mandated coding and classification systems, and office resources to select the appropriate diagnostic and procedural codes.

13. Assists and educates physicians and other clinicians by advocating proper documentation practices, further specificity and re-sequencing or inclusion of diagnoses or procedures to more accurately reflect the acuity, severity and occurrence of events.

14. Consults physicians for clarification / additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.

15. Ensures accurate, complete and consistent coding practices for the production of quality healthcare data.

16. Adheres to the ICD coding conventions, official coding guidelines, CPT rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets.

17. Assists and collaborates with clinical and non-clinical departments regarding proper documentation, coding conventions, and official coding guidelines.

18. Routinely abstracts clinical information from the medical record according to department procedure.

19. Assists in training of other staff in computer applications and department procedures as needed.

20. Verifies patient identities to ensure correct filing of patient information.

21. Other duties as assigned, such as special coding projects.

QUALIFICATIONS

1. Associates degree, or minimum of two (2) years of coding experience, including clinical data abstraction and coding systems.

2. CCS, CPC-H, RHIA, or RHIT required.

3. Knowledge of medical terminology.

4. Coursework in anatomy and physiology required.

5. Demonstrated understanding of various coding and reimbursement systems including ICD, CPT, DRG and ASC, required.

6. Must be able to meet or exceed department productivity and quality standards.

7. Ability to analyze and interpret clinical data with demonstrated critical thinking skills to make appropriate interventions.

8. Excellent verbal and written communication skills.

9. Proficiency in working with PC, Microsoft Office, Lotus Notes or other email, and the internet.

10. Ability to work independently.

11. Must pass the Genesis Healthcare System coding exam with a 90%.

WORKING CONDITIONS / PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit up to 8 hours.

2. Ability to maintain concentration during times of frequent interruptions.

3. Ability to read handwritten and printed material, and computer monitor.

4. Ability to tolerate stress related to the mental and physical demands of the position.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

Benefits include :

• Medical and dental insurance
• Vision insurance
• Healthcare spending account
• Dependent care spending account
• Basic life insurance
• Disability insurance
• Tuition reimbursement
• Employee Assistance Program
• Paid time off
• Opportunities for professional development
• Career ladders
• Gym membership benefits
• Employee health management programs
• Free virtual mental health services

Last updated : 2024-06-10