E&M/Specialty Coder

<div><strong>Job Summary:</strong></div><p>Under direct supervision, the E&M/Specialty Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from appropriate documentation in the medical record, assigns codes and modifiers with ICD-CM, CPT and HCPCS Level II codes.  <br>All work is performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines.</p><div><br><strong>Essential Responsibilities:</strong></div><ul style="margin-bottom:0;margin-left:1px;margin-top:0;"><li>Review Medical Records to identify diagnoses/procedures.</li><li>Under supervision, codes all diagnostic and operative information from the medical record using ICD-CM, CPT and HCPCS coding classification systems.  </li><li>Verifies and abstracts all medical data from the record to assign appropriate codes for the following settings: Inpatient Hospital (IP), Hospital Emergency (ED), Hospital observation (HOPS), Hospital Ambulatory (HAS) Hospital Outpatient (HOV) and Medical<ul style="margin-bottom:0;margin-left:1px;margin-top:0;"><li>Office.</li><li>E&M/Specialty Coder may require specialty coding and will remain part of the responsibilities as long as business dictates.</li><li> </li><li>Corrects data as appropriate.</li><li> </li><li>Review Medical Records to resolve Ingenix and HealthConnect Coding Edits.</li><li> </li><li>Under supervision, identify and resolve coding related edits by reviewing the medical record and ensuring that all data and codes are consistent with ICD-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, MediCal, USDOL, as well as KP Regional and Local policies.</li><li>Corrects data as appropriate.</li><li> </li><li>Work Organization and Prioritization.</li><li> </li><li>Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved, in a timeframe that will assure compliance with regulatory, billing and SOX requirements.</li><li> </li><li>Completeness of Medical Record Data.</li><li> </li><li>Under general supervision, interacts with clinical contracts to clarify and promote accurate documentation of patient diagnostic and procedural information.</li><li>Enters patient information into the computerized medical record and billing systems, ensuring the accuracy and integrity of the medical record data abstracted or encounter</li><li>data corrected, prior to submitting the data.</li><li>Ensures timely data completion by meeting coding/abstracting productivity/quality standards established for the E&M/Specialty Coder position in the current Coder Work At</li><li>Home agreement.</li><li>Provides feedback to monitor service provider and line of business compliance with regulatory requirements.</li><li>Confidentiality / Security of Systems Maintains and complies with policies and procedures for confidentiality of all patient records.</li><li>Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems.</li><li>Other Duties: Answers the telephone promptly and identifies themselves and the department.</li><li>Acts as a resource person to other departments regarding coding questions and issues.</li><li>Performs other duties as assigned.</li></ul></li></ul><p> </p><p>Grade 594</p><br><br><div> <b>Basic Qualifications:</b></div> <div> <u>Experience</u></div> <ul style="margin-top: 0;margin-left: 1px;margin-bottom: 0;"> <li>Minimum two years, within the last three years, certified professional coding experience.</li> </ul><div> <u>Education</u></div> <ul style="margin-top: 0;margin-left: 1px;margin-bottom: 0;"><li>High School Diploma or GED.</li><li>Completion of classes in medical terminology, anatomy, physiology, current ICD CM and CPT coding conventions, and disease process from an accredited program is required.</li></ul><div> <u>License, Certification, Registration</u></div> <ul style="margin-top: 0;margin-left: 1px;margin-bottom: 0;"><li>Certified Coding Specialist - Physician Based OR Certified Professional Coder OR Registered Health Information Technician </li></ul><div> <b>Additional Requirements:</b></div> <ul style="margin-top: 0;margin-left: 1px;margin-bottom: 0;"><li>Achieve a minimum score of 80%25 on the E&M/Specialty Coder test.</li><li>Basic knowledge of and use of computer keyboard </li><li>Must be able to meet production and quality standards established for the position.</li><li>Demonstrated knowledge of anatomy, physiology, medical terminology and disease processes.</li><li>Demonstrated ability to understand the clinical content of a health record. </li><li>Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing. </li><li>Basic knowledge of reimbursement methodologies and conventions.</li><li>Knowledge of rules and guidelines for current coding classifications.</li><li>Practical knowledge of hospital and/or physician clinic based revenue cycle</li><li>Practical knowledge of professional series coding and billing in a multi-specialty environment.</li><li>Practical knowledge of government and other payer coding, billing and collection rules and regulations.</li><li>Must maintain current coding credential and perform associated Continuing Education Units. </li><li>Must abide by the AHIMA and/or AAPC code of ethics.</li><li>Must be willing to work in a Labor Management Partnership environment.</li></ul><div> <b>Preferred Qualifications:</b></div> <ul style="margin-top: 0;margin-left: 1px;margin-bottom: 0;"><li>N/A</li></ul>