Certified Coder Job at The South Bend Clinic
Job Description:
POSITION: Certified Coder
DEPARTMENT: Business Office
REPORTS TO: Billing and Coding Supervisor
REVIEWED BY: Director of Business Office and Human Resources
STATUS: Non-Exempt
REVIEW CATEGORY: Business Office
REVISION DATE: 02/29/2020
SUPERCEDES: 04/02/2012
POSITION SUMMARY: Position audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of clinical coding to provide second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Assists with formal training programs by assessing performance levels, determining training needs, and formulating training materials. Assists in the review, development and modification of policies, procedures and/or systems to achieve and maintain compatibility with billing requirements.
POSITIONS SUPERVISED: None.
ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES:
Knowledge, Skills, and Abilities:
Prior experience directly related to the duties and responsibilities specified is preferred. Knowledge of medical terminology and medical coding. Knowledge of patient care charts and patient histories. Knowledge of legal and policy constraints pertaining to patient billing. Knowledge of auditing concepts and principles. Computer literacy as well as knowledge of Microsoft Outlook, Excel and Word. Ability to analyze and problem solve. Ability to gather data, compile information and prepare reports. Ability to communicate effectively, verbally and in writing. Ability to provide guidance and coding support to employees in any clinical area. Ability to work with staff to successfully implement new coding policies and procedures in any clinical setting as well as formulate training materials. Ability to communicate technical information to non-technical personnel. Ability to assess provider compliance with billing regulations and define areas in which additional training is required to meet standards. Ability to use independent judgment to manage and impart confidential information.
Special Demands/Requirements:
None
ADA JOB REQUIREMENTS:
Physical Requirement:
Visual Acuity:
Environmental Conditions:
POSITION: Certified Coder
DEPARTMENT: Business Office
REPORTS TO: Billing and Coding Supervisor
REVIEWED BY: Director of Business Office and Human Resources
STATUS: Non-Exempt
REVIEW CATEGORY: Business Office
REVISION DATE: 02/29/2020
SUPERCEDES: 04/02/2012
POSITION SUMMARY: Position audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of clinical coding to provide second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Assists with formal training programs by assessing performance levels, determining training needs, and formulating training materials. Assists in the review, development and modification of policies, procedures and/or systems to achieve and maintain compatibility with billing requirements.
POSITIONS SUPERVISED: None.
ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES:
- Audits medical record documentation to identify incorrectly coded services and prepares reports of findings.
- Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
- Obtains clarification of conflicting, ambiguous, or non-specific documentation.
- Analyzes and interprets complex patient medical records to identify and determine amount and nature of billable services, in any clinical area.
- Ensures strict confidentiality of financial and medical records.
- Attends coding conferences and workshops to receive updated coding information and changes in coding and/or regulations.
- Follows established departmental policies, procedures and objectives, compliance objectives safety and environmental standards.
- Performs miscellaneous job-related duties as assigned.
POSITION REQUIREMENTS:
Education/Certification/License:
High School graduate or GED equivalent is required. Certified Coding Specialist (CCS); Certified Coding Specialist – Physician Based (CCS-P); Certified Professional Coder (CPC); Registered Health Information Technician (RHIT) or eligible required. Previous coding experience preferred.
High School graduate or GED equivalent is required. Certified Coding Specialist (CCS); Certified Coding Specialist – Physician Based (CCS-P); Certified Professional Coder (CPC); Registered Health Information Technician (RHIT) or eligible required. Previous coding experience preferred.
Knowledge, Skills, and Abilities:
Prior experience directly related to the duties and responsibilities specified is preferred. Knowledge of medical terminology and medical coding. Knowledge of patient care charts and patient histories. Knowledge of legal and policy constraints pertaining to patient billing. Knowledge of auditing concepts and principles. Computer literacy as well as knowledge of Microsoft Outlook, Excel and Word. Ability to analyze and problem solve. Ability to gather data, compile information and prepare reports. Ability to communicate effectively, verbally and in writing. Ability to provide guidance and coding support to employees in any clinical area. Ability to work with staff to successfully implement new coding policies and procedures in any clinical setting as well as formulate training materials. Ability to communicate technical information to non-technical personnel. Ability to assess provider compliance with billing regulations and define areas in which additional training is required to meet standards. Ability to use independent judgment to manage and impart confidential information.
Special Demands/Requirements:
None
ADA JOB REQUIREMENTS:
Physical Demands:
Stooping/Kneeling/Crouching/Reaching/Standing/Walking/Pushing/Pulling/Lifting/Fingering/Grasping/Feeling/Talking/Hearing/Repetitive Motions
Physical Requirement:
Sedentary Work - Exerting up to 10lbs of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time. Jobs are sedentary if walking is required only occasionally and all other sedentary criteria are met.
Visual Acuity:
Biomedical/Equipment Operators, Inspection, Testing, Analysis, Close Assembly, Clerical, Administrative
Environmental Conditions:
None. The worker is not substantially exposed to adverse environmental conditions as typical with office administrative work.
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