Physician Coder I

Summary :

Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas / record types to ensure proper billing and compliance.

Responsibilities :

• Reviews medical record documentation to determine all appropriate diagnostic, procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.
• May assign and sequence diagnostic, CPT (Current Procedural Terminology) procedure codes (minimal) and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and / or department coding policies and procedures. Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Researches medical record for any additional diagnoses documented to meet medical necessity.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• Enhances and maintains coding knowledge and skills.
• Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes.
• Conducts audits and / or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
• For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors and / or account edits preventing completion of coding and / or billing. Makes appropriate coding corrections, when advised, and follows procedure to notify billing.
• Communicates with insurance companies about coding errors and disputes (physician billing).
• Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
• Submits daily productivity report to HIM manager by defined deadline.
• Meets and maintains HIM coding quality and productivity standards.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
• Performs all other duties as requested.

Education and Certification Requirements : High School Diploma or Equivalent (Required) Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)

Required Work Experience : O ne (1) year diagnostic / procedural office coding experience with surgical coding experience

For Physician Billing : Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCSP) by AHIMA.