Coder - Certified en NextCare

POSITION SUMMARY:

The Coder reviews, analyzes, and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines and appropriate reimbursement requirements. The coding function is the primary source for data and information used in healthcare today, and promotes provider/patient continuity and accurate database information. The coding function also ensures compliance with established third party reimbursement policies and regulations.

ESSENTIAL FUNCTIONS:

• Abstracts all necessary information, assigns and sequences ICD-9-CM, CPT, and HCPCS codes which most accurately describe each documented diagnosis and procedure according to established government and private healthcare guidelines.

• Assures the final diagnoses and all other procedures as stated by the physician/provider are valid and complete.

• Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.

• Quantitative analysis -- Performs a comprehensive review for the medical record to assure patient and record identification, provider signatures and dates, and other necessary data are complete and accurate in the presence of all reports which appear to be indicated by the nature of the treatment rendered.

• Qualitative analysis -- Evaluates the medical record for documentation consistency and adequacy. Ensures that the final diagnosis and procedures accurately reflects the care and treatment rendered.

• Reviews the medical records for compliance with coding rules and regulations according to regulatory agencies for state Medicaid plan, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and other third party agencies as well as the Official ICD-9-CM Guidelines for Coding and Reporting and company coding guidelines.

• Analyze provider documentation to assure the appropriate Evaluation and Management (E&M) levels are assigned using the correct CPT code.

• Refers inconsistent patient treatment information/documentation to coding quality analysis, Senior Coder or Supervisor for clarification/additional information for accurate code assignment.

• Completes daily batches assigned by Senior Coder or Medical Coding Supervisor according to department quality and quantity goals.

• Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.

• Performs other related duties as assigned or described in Company policy.

TASKS:

Please see corresponding Task List for additional responsibilities

ESSENTIAL SKILLS AND EXPERIENCE:

Education: Minimum of High School Diploma or equivalent

Certification: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) in an active Status with American Health Information Management Association or American Academy of Professional Coders

Experience:

Minimum of one or more years of experience providing coding for professional services and acute care facilities

Must demonstrate a level of knowledge and understanding of ICD9 and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders. Must be able to achieve an acceptable accuracy rate on the coding test administered by the coding department supervisor/manager according to pre-established company standards

Must be able to work effectively with common office software and coding software and abstracting systems.

VALUED BUT NOT REQUIRED SKILLS AND EXPERIENCE:

Education:

Experience:

REPORTING TO THIS POSITION:

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands:

While performing the essential functions of this job, the employee is occasionally required to stand; walk; sit; lift; carry; use hands to handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop; kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds.

Work Environment:

While performing the essential functions of this job, the employee will be exposed to working conditions commensurate with a traditional office environment.