Certified Coding Specialist-BRGP
Job description
JOB PURPOSE OR MISSION: Assigns diagnostic and procedure codes to records of discharged patients and coordinates the follow-up on deficient/delinquent discharge records, under the direction of a senior level employee. Performs duties appropriate to the need of the age population served, as defined in the department’s scope of service.
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
- Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
- Takes initiative in living our Everyday Excellence values and vital signs.
- Takes initiative in identifying customer needs before the customer asks.
- Participates in teamwork willingly and with enthusiasm.
- Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
- Keeps customers informed, answers customer questions, and anticipates information needs of customers.
CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.
- Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
- Maintains accurate and reliable patient/organizational records.
- Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.
CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
- Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
- Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
- Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
- Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
- Initiates or redesigns to continuously improve work processes.
- Contributes ideas and suggestions to improve approaches to work processes.
- Willingly participates in organization and/or department quality initiatives.
CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
- Effectively manages time and resources
- Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.
- Consistently looks for and uses resource saving processes
CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
- Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
- Employee proactively reports errors, potential errors, injuries or potential injuries.
- Employee demonstrates departmental specific patient and employee safety standards at all times.
- Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.
JOB FUNCTIONS
1. Identifies and codes records for the purpose of reimbursement, data analysis, research and compliance with federal regulations.
- Codes records within 3 days of discharge 98% of the time while maintaining a coding accuracy rate of 95%.
- Abstracts records within 3 days of discharge 98% of the time while maintaining an abstracting accuracy rate of 98%.
- Demonstrates a complete understanding of all guidelines concerning the coding and the sequencing of diagnoses and operations/procedures.
- Codes discharge records in order of priority as assigned by the supervisor.
- Inputs data into computerized health information system.
- Demonstrates a thorough working knowledge of the medical coding systems.
- Maintains control procedures to assure accuracy and completeness of coded information
2. Follows up on deficient and delinquent discharge records to assure compliance with Medicare, Medicaid and departmental rules and regulations.
- Requests information on diagnoses or procedures from physicians when not recorded on discharge.
- Identifies deficiencies important for coding purposes.
- Audits incomplete charts that have been identified for deficiencies on a biweekly basis.
- Investigates missing records and notifies supervisor if not found within 2 days of discharge.
3. Performs all other duties as assigned.
EXPERIENCE REQUIREMENTS
One-year non-credentialed inpatient Medicare coding experience preferred or
3 years general coding experience
EDUCATIONAL REQUIREMENTS
High School Graduation preferred
SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS
Must be a certified coder with at least 6 months of direct coding experience.
HIPAA REQUIREMENTS:
Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: Medical records without limitation including both paper and electronic records, patient demographics, patient information related to surgery or appointment schedules, information related to patient location, religious beliefs, lab or radiology results.
SAFETY REQUIREMENTS:
Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: Incident reporting, personal protective equipment (PPE), exposure control plans, hand washing, environment of care.
Must be a certified coder with at least 6 months of direct coding experience.
EXPERIENCE REQUIREMENTS
One-year non-credentialed inpatient Medicare coding experience preferred or
3 years general coding experience
EDUCATIONAL REQUIREMENTS
High School Graduation preferred
Coder certification required
Review documentation in medical records from all service and assign ICD-10 and CPT codes based on current and potential coding policies
Review and respond to coding/billing questions from providers and staff
Conduct coding reviews and on-going training programs to assure coding quality
Identify and explain differences in coding between the original coder, auditor and the coding specialist
Conduct new provider coding training
Research any coding issues
Research updated coding information
Attend the Compliance Committee and Central Billing Office meetings as needed
Assigns appropriate ICD-10-CM and or CPT-4 codes/modifiers upon review of the medical record documentation
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