PHMC is proud to be a leader in public health. PHMC requires that all employees are fully COVID-19 vaccinated by the first day of employment. We will offer the Covid-19 vaccination at no cost, via our Health Centers.

Mission Statement:

Our Mission is to be the premier regional provider of integrated, community-based healthcare by combining evidence-based clinical practices, outstanding patient service, innovative care partnerships, and team-driven excellence, within a healthy fiscal environment.

Job Description:

Under general supervision, reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes office procedures for providers to ensure proper reimbursement. Provides education to the providers to ensure proper completion of Electronic Health Records and proper assignment of ICD-10-CDM, HCPCS and CPT codes.

Age/Patient Populations Served(Double-click on box to activate appropriate indicator)

Essential Duties and Responsibilities:

• Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies and to ensure proper submission of services prior to billing on pre-determined selected charges
• Supplies correct ICD-10-CM diagnosis codes on all diagnoses provided
• Supplies correct HCPCS code on all procedures and services performed
• Supplies correct CPT code on all procedures and services performed
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Ensure that sequence of codes meets criteria and established practice.
• Contact provider with questions about treatment or diagnostic tests with regard to coding procedures.
• Contact providers to train and update them with correct coding information
• Collaborate with billing department to ensure all bills are satisfied in a timely manner
• Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Attends seminars and in-services as required to remain current on coding issues
• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct.
• Reports compliance problems appropriately working in close collaboration with the Compliance Officer and Performance Improvement Officer.
• Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
• Performs other related duties, which may be inclusive, but not listed in the job description

PHMC Compliance Responsibilities:

• Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistle Blowers and Conflict of Interest Policies.
• Keeps abreast of all pertinent federal, state and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
• Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
• Comply with Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies standards.
• Adhere to all PHMC Policies and Procedures.
• Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.

JOB REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS:

• Excellent interpersonal skills
• Computer competency
• Knowledge of federal laws and regulations affecting coding requirements
• Knowledge of principles, practices and methods of current coding certificate required.
• Knowledge of billing practices required, FQHC billing preferred
• Knowledge of medical records, EHR required
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must have good math skills and effective communication skills.
• Perform coding work requiring independent judgment with speed and accuracy
• Examine and verify coding errors through audits
• Communicate clearly and concisely, orally and in writing
• Must have the ability to work independently to accomplish assigned work in a timely manner

EXPERIENCE:

• Three years’ experience using ICD-9-CM, CPT, HCPCs or equivalency, and at least 1 year with ICD 10
• Proficient knowledge of medical billing and coding practices and procedures, preferably in a FQHC environment.
• Ability to process and maintain confidential matters and information.
• Knowledge of Allscripts EHR application or another EHR preferred.

EDUCATION:

• High School Diploma
• Medical Coding Certificate - RHIT or CPC certification is required

PHYSICAL DEMANDS:

• Position requires standing 2/3 of the time, walking 2/3 of the time, requires sitting under 1/3 of the time, use of hands to finger, handle or feel 2/3 of the time, reach with hands and arms, under 1/3 of the time, talk or hear over 2/3 of the time.

WORK ENVIRONMENT:

• Moderate noise

Salary:

• Based on education and experience.
• Pay Grade - 15