Medical Coding Specialist II
Category: Clerical
Facility: Genesis Medical Group
Department: GMG - Physician Coding
Schedule: On-Call
Shift: Varied Shifts
Contact Information: Contact: Human Resources
Job Details:

JOB SUMMARY

Works one-on-one with physicians to ensure optimal, correct, and timely coding. Conduct physician coding audits and create accuracy reports and summaries to provide audit feedback to the physician and documentation of the audit findings.  Collects, aggregates and analyzes patient information from Genesis Medical Group physicians to code and bill charges.  Codes medical claims along with charge entry and daily reconciliation. 

 

ESSENTIAL DUTIES

1.     Audits coding selections and educates physicians to ensure compliant and timely coding within the requirements of Genesis Medical Group by working one-on-one with each physician as assigned.

2.     Optimizes reimbursement, which Genesis HealthCare System is legally entitled, by applying effective coding strategies.

3.     Reviews and applies coding and reimbursement resources in a timely manner to ensure an up to date knowledge base.

4.     Assigns and reports codes that are clearly and consistently supported by physician documentation in the health record.

5.     Discerns clinical notes, uses skills, and knowledge of currently mandated coding and classification systems, and office resources to select the appropriate diagnostic and procedural codes.

6.     Assists and educates physicians and other clinicians by advocating proper documentation practices, further specificity and re-sequencing or inclusion of diagnoses or procedures to more accurately reflect the acuity, severity and occurrence of events.

7.     Consults physicians for clarification/additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.

8.     Ensures accurate, complete and consistent coding practices for the production of quality healthcare data.

9.     Adheres to the ICD coding conventions, official coding guidelines, CPT rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets.

10.   Assists and collaborates with other departments regarding proper documentation, coding conventions, and official coding guidelines.

11.   Consistently applies coding and reimbursement rules to ensure appropriate coding.

12.   Routinely abstracts clinical information from the medical record according to department procedure.

13.   Identifies and reports inappropriate coding practices.

14.   Assists in training of other staff in computer applications and department procedures.

15.   Verifies patient identity to ensure correct filing of patient information.

 

QUALIFICATIONS

1.     Associates degree, or minimum of two (2) years experience working in HIM field gaining understanding of Federal HIM regulations.

2.     One-year experience working with clinical data abstraction and coding systems.

3.     Must possess one of the following certifications: CCS, CPC, RHIA, or RHIT, or must obtain within 18 months after hire.

4.     Knowledge of medical terminology and anatomy and physiology, required.

5.     Demonstrated understanding of various coding and reimbursement systems including ICD and CPT required.

6.     Ability to analyze and interpret clinical data with demonstrated critical thinking skills to make appropriate interventions.

7.     Excellent verbal and written communication skills.

8.     Proficiency in working with PC, MS Windows, MS Office Lotus Notes and the internet.

9.     Ability to work independently.

10.   Must pass Genesis Healthcare System’s diagnostic/Emergency Department coding exam with a 90%.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

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

 

1.     Ability to sit up to 8 hours.

2.     Ability to maintain concentration during times of frequent interruptions.

3.     Ability to read handwritten and printed material, and computer monitor.

4.     Ability to tolerate stress related to the mental and physical demands of the position.

 

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

 




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