What are the responsibilities and job description for the Coding Specialist I position at Parkland Health?
Location: Virtual Employee
Primary Purpose
The Primary Purpose of the Coding Specialist I is to code and verify charge data necessary to ensure correct coding, charging, abstracting, billing on Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters for professional billing. This position requires the coder to be highly proficient in the proper assignment/verification of evaluation and management (E/M), ICD-10-CM, CPT, HCPCS, HCC, HEDIS CAT II and modifier assignment.
MINIMUM SPECIFICATIONS
Education
Primary Purpose
The Primary Purpose of the Coding Specialist I is to code and verify charge data necessary to ensure correct coding, charging, abstracting, billing on Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters for professional billing. This position requires the coder to be highly proficient in the proper assignment/verification of evaluation and management (E/M), ICD-10-CM, CPT, HCPCS, HCC, HEDIS CAT II and modifier assignment.
MINIMUM SPECIFICATIONS
Education
- High school diploma required
- Must successfully completed an approved coding program
- OR Must be a graduate of a Health Information Management program.
- Zero (0) years of experience required, however, one (1) year of related experience in a acute care setting or diverse clinical specialties preferred.
- Physician office coding, charging and billing experience preferred.
- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.
- Because of the lag in SCCE, HCCA, NCRA, and AHIMA updating the status of certifications, current employees whose certification is granted through one of these associations are allowed up to seven (7) calendar days, after expiration, to provide proof of renewal. Although an additional seven (7) calendar days is allowed to provide proof of renewal, there cannot be a lapse in the certification's 'active' status.
- Must have a Certified Coding Associate (CCA) certification OR
- Must be certified through the American Health Information Management Association as one of the following:
- Registered Health Information Management Technician (RHIT)
- Registered Health Information Management Administrator (RHIA)
- Certified Coding Specialist (CCS)
- Certified Coding Specialist ' Physician Based (CCS-P)
- Must be certified through the American Association of Procedural Coders (AAPC) as one of the following:
- Certified Professional Coder (CPC)
- Certified Outpatient Coder (COC)
- Certified Professional Coder Apprentice (CPC-A)*
- Certified Professional Coder-Hospital (CPC-H)
- Certified Professional Coder-Hospital Apprentice (CPC-H-A)* *If hired with CPC-A or CPC-H-A certification, employee must have apprentice designation removed from their certification within two years to continue in Coder I classification.
- Must score a minimum of 70% on a pre-employment inpatient/outpatient coding test. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.
- Strong coding and charge review skills understanding the utilization of modifiers and other coding, charging and billing rules to include AMA and other state and federal organizations.
- Strong knowledge of ICD-9/ICD-10-CM, CPT-4/HCPCS, HCC and HEDIS CAT II coding and abstracting, applicable coding edits and general knowledge of Local Coverage for professional billing.
- Score a minimum of 70% on a pre-employment outpatient coding assessment. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.
- Strong working knowledge of medical terminology, the human disease process, anatomy and physiology.
- Ability to demonstrate an increased proficiency in CAC and coding encoder skills within three (3) months of employment.
- Moderate MS Office suite skills and working knowledge of electronic health records, Computer Assisted Coder (CAC) and encoder software
- Knowledge of Epic EHR and 3M 360 coding and abstracting software is preferred.
- Codes and conducts charge quality review of all episodes of care for Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters according to coding and billing guidelines and hospital policy.
- Assigns appropriate evaluation and management (E/M) level, ICD 10-CM, CPT, HCPCS, HCC and/or HEDIS CAT II code according to the Centers of Medicare & Medicaid Services (CMS), AHA, AMA and other state and federal requirements.
- Achieve and maintain 95% accuracy on quality reviews and productivity standards.
- Verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.
- Updates, as appropriate, patient database with classification codes to provide sufficient patient health information according to Parkland's standards.
- Stays abreast of the latest developments, advancements, and trends in the field of health information management by attending seminars/workshops, reading professional journals, actively participating in professional organizations and integrates knowledge gained into current work practices.
- Identifies ways to improve work processes and improve customer (internal as well as external) satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
- Facilitates a positive working relationship with physicians, nurses, and medical staff and hospital employees to ensure that all work related encounters are productive.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the Coding area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
- Maintains CE hours and renew annual coding credentials.
- Routine Screenings/Proof of Immunizations Exclusions: Virtual workforce employees as defined by Parkland's Virtual Work procedure, and as specified in their job descriptions, are not required to undergo routine screening for communicable diseases including TB, the flu vaccination, or the COVID-19 vaccination.
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.