Medical Coder II - HIM Hospital Coding

Responsibilities

• Assigns International Classification of Diseases (ICD-10-CM) diagnosis codes in an accurate and productive manner.
• Assigns all diagnosis codes to chronic conditions documented that may impact Hierarchal Condition Categories (HCCs) or expected mortality.
• Assigns Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in an accurate and productive manner.
• Groups codes and completed product into payment groups.
• Analyzes information for optimal and proper reimbursement.
• Reviews National Coverage Determination (NCD), Local Coverage Determination (LCD), and Correct Coding Initiative (CCI) edits and any other coding edits and applies changes to code assignments appropriately, and/or adds modifiers appropriately.
• Recognizes and has knowledge of Medical Necessity requirements and resolves edits during code assignments.
• Ensures compliance with all appropriate coding, billing and data collection regulations and procedures.
• Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
• Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, and other services provided.
• Obtains missing information and/or clarifies existing information.
• Accepts feedback from Auditor as needed to avoid future errors.
• Researches appropriate databases for validation of information.
• Utilizes a variety of software (e.g. Epic, Optum CAC, MS Office, etc.) to compile and validate medical information.

Requirements

• Education Requirements: High School diploma or GED
• Licensure/Certification Requirements: Successful completion of the UNC HCS Hospital Outpatient Coder Proficiency Test. One of the following certifications: - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential
• Professional Experience Requirements: Twelve (12) months of experience in hospital coding.
• Knowledge/Skills/and Abilities Requirements: Strong knowledge of ICD-10-CM and HCPCS/CPT coding with strong analytical and data mining skills. Ability to effectively manage projects. Ability to work effectively with various levels of staff (including on-site and remote). Must possess strong communication skills, both written and verbal and have extensive attention to detail. Exhibits effective organizational skills, time management, and management of multiple priorities. Ability to interpret moderately complex medical conditions and work with complex coding applications. Ability to have an excellent balance of being highly productive and yet produce high quality work. Ability to interpret federal and state regulations as they relate to coding and compliance.