Roles and Responsibilities
Assign and sequence ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented information. Assure the final diagnoses and procedures as stated by the provider are valid and complete. Extract necessary information from health records to identify secondary complications and co-morbid conditions.
Perform comprehensive review for the record to assure presence of information such as: patient and record identification, signatures and dates, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
Evaluate the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review the records for compliance with established third party reimbursement agencies and special screening criteria.
Analyze provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code.
Operate peripheral equipment (CRT and printer) for the purpose of key-entering data for the process of updating or changing health summaries for patient information files.
Perform all duties according to established safety procedures and Tribe policy.
Liaise with providers and other parties to clarify information. Advise and train providers and staff on medical coding.
Perform chart coding audits.
Communicate with supervisor of issues with Electronic Health Record.
Performs other duties assigned by the Revenue Cycle Manager or designee.
Advanced knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology, major disease processes, pharmacology, and the metric system to identify specific clinical findings, to support existing diagnoses
Advanced knowledge of medical codes (ICD-10-CM, Volumes 1-3, CPT, HCPCS, and IHS coding conventions.
Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc. to a stated diagnosis to assign the correct ICD-10-CM code.
Advanced knowledge of medical codes involving a selection of most accurate and descriptive code using the CPT codes for billing of third party resources.
Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
Knowledge of Electronic Health Record (EHR) in order to analyze encounters and notify providers of data that needs corrections through EHR broadcasts, notifications, and templates.
Must have good math skills and effective communication skills.
Must be knowledgeable of the fiscal requirements, policies, and procedures of federal, state, and tribal programs.
Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data. Requires skill in the use of the wide variety of office equipment including: computer, calculator, facsimile, copy machine, scanner, and other office equipment as required.
Must be able to follow instructions and work independently.
High School Diploma or Equivalent
2+ Years' of coding experience using ICD-10-CM or equivalency
CCS, CCS-P, or CPC Certification is REQUIRED; Employee is required to maintain certification throughout employment.
No travel requirements.