Medical Coder III - Hospital OP

Responsibilities

• Assigns International Classification of Diseases (ICD-10-CM) diagnosis codes in an accurate and productive manner.
• Assigns all 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 and other services provided.
• Obtains missing information and/or clarifies existing information.
• Accepts feedback from Auditor as needed to avoid future errors.
• Accepts feedback from PWC Smart reviews and makes edits as needed to avoid future errors.
• Reviews and processes PWC SMART edits.
• 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
• Successful completion of the UNC HCS Hospital OP Coder Proficiency Test.
• Licensure/Certification Requirements: Must have one of the following - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential
• Professional Experience Requirements: Two (2) years of experience in hospital coding.

Knowledge/Skills/and Abilities

• Strong knowledge of ICD-10-CM and HCPCS/CPT coding with excellent analytical and data mining skills.
• Strong knowledge of Ambulatory Payment Classification (APC) system for outpatient cases.
• Ability to effectively manage projects.
• Ability to effectively work with various levels of staff (including on-site and remote).
• 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 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.