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Employee Type:
Regular Work Shift:
Day - 8 hour shift (United States of America) Join Team Tidelands and help people live better lives through better health!
Medical Coder/Coding Specialist II
Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day.
A Brief Overview
Medical Coder II is responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT, and HCPCS codes to all outpatient, ED, and hospitalists accounts, both facility and professional, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and organizations policy and procedure. Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responsible for resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement of service rendered and to maintain an industry standard clean claim rate. May assistant with writing appeals letters. Assist with training to include team members and physicians.
What you will do
Analyzes medical records, interprets documentation, and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD 10 CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software to include Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material as required.
Enters charges for procedures that are not soft coded as instructed for certain patient types. Codes complex diagnostic and procedural accounts.
Completes a daily basis cases that has been assigned to them utilizing the appropriate work lists/work queues.
Works closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions. Assist Patient Financial Service (PFS) with written appeal letters, dispute determination responses, and redetermination to support reimbursement of services rendered.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Review and resolve account checks, clearinghouse rejection errors, denials, and charge review/claim edits daily. Also reviews accounts returned from various departments and processes corrections for clean claim submission or posts claim denial review for appeal.
Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations.
Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record.
Verify accurate abstracting of discharge disposition Assist in training new coders to become acclimated to the environment and in understanding internal coding policies and procedures, and documentation guidelines.
Education Qualifications High School Diploma or equivalent Preferred
Experience Qualifications Minimum of two years of progressive on-the-job coding experience in an acute care hospital or physician's office or successful completion of Tidelands Health coding cross-training program
Skills and Abilities
Analyze clinical data and interpret information.
Have knowledge of payer guidelines related to MUE, Medical Necessity, LCD/NCD requirements and HIPAA/Compliance Ability to assign ICD-10-CM, CPT and/or HCPCS codes to complex diagnoses and procedures in an integrated system of outpatient and emergency records.
Solid knowledge of hospital documentation, and coding workflows and terminology; Solid understanding of and ability to apply Coding Clinic and other coding guidelines.
Proficient at writing AHIMA-compliant physician queries Adept at comparing documentation, code assignment, and charge in the financial system for accuracy and completeness and elevating concerns to the appropriate manager Proficient in researching and responding to Business Office questions and/or questions by the payer Works collaboratively with PFS, Quality, Compliance, and other facility leadership Functional knowledge of facility EMR, 3M encoder, CDI tool, and other support software Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency Strong analytical capabilities.
Strong organizational skills.
Advanced ability to function independently and be a self-starter Outstanding research skills and ability to use independent judgment to solve problems Handle multiple priorities.
Listen and acknowledge ideas and expressions of others attentively.
Converse clearly using appropriate verbal and body language.
Collaborate with others to achieve a common goal through cooperation.
Influence others for positive and productive outcomes.
Licenses and Certifications
Registered Health Information Administrator - American Health Information Management Association Required or
Registered Health Information Technician - American Health Information Management Association Required or
Certified Professional Coder - American Academy of Professional Coders Required or
Certified Coding Specialist - American Health Information Management Association Required or
Certified Outpatient Coder (COC) Required
Physical Demand
Light Physical Demand
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description. Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.