Job Description

GENERAL SUMMARY:

 Under the direct management of the Manager of Business Development, PFS, in response to inquiries and requests from the RAC Contractors, the coder documents, tracks, and monitors the progress of the requests and timeliness of the responses.  The coder evaluates and monitors physicians' professional coding of evaluation and management (E&M) and other CPT-4 procedural codes for accuracy of these post claim submission inquiries.  Such monitoring involves the interpretation and analysis of medical record documentation and application of correct coding principles as defined by regulatory agencies (such as CMS, AMA, The Coding Clinic) and standards of ethical coding.  After determination of coding accuracy (including decisions related to global periods, modifiers, bundling rules) as well as identifying missing codes, appropriate codes, related charges are processed through the RAC program based on compliance of the coding documentation.  Coder discusses discrepancies between documentation and code selection with the physician/provider for clarification and educational purposes.  Maintains knowledge base by reviewing coding and reimbursement newsletters, attending in-service training sessions and participating in continuing education workshops.

MINIMUM QUALIFICATIONS:

Education, Knowledge, Skills and Abilities

• Specific training related to CPT procedural coding and ICD-9-CM diagnostic coding through continuing education programs/seminars and/or community college. 
• Working knowledge of human anatomy and  physiology, disease processes, demonstrated knowledge of
• medical terminology, organization of the medical record and medical record coding systems.
• Analytical ability sufficient to accurately abstract, code and interpret data from diverse sources.  
• Requires strong verbal and written communication skills. 
• Must  be detail oriented; possess ability to perform duties with minimum direct supervision; ability to
• organize and record information appropriately and resolve problems independently.  Computer literacy required. 

Associates Degree in HIM with RHIT certification may substitute for above work experience.

Required Length and Type of Experience

• One year's recent experience in the selection of ICD-9-CM and CPT codes based on interpretation of clinical data from medical records or equivalent related experience.  
• One of the following coding certifications:  CPC, CCS-P, CMC or RHIT.

Required Licensure and Certification

Required Physical

• Manual dexterity required to locate and lift medical charts. 
• Ability to work under stress and to meet imposed deadlines.

• Typical physical demands involve prolonged sitting and/or traveling through various locations in thehospital and dexterity to accurately operate a data entry/PC keyboard. 

 -HDS-

Benefits

Medical, Dental, Disability, Prescription, Vision, Life, Holidays, 403B, Retirement Plan, Flexible Spending, Paid Time Off, Tuition Reimbursement