General Information
| Job Description | HEALTH INFO CODER 3 | Working Title | Medical Coder - Women's Health |
|---|---|---|---|
| Job Code | 004733 | Grade | |
| Department Name | SOM OB/GYN - D02015 | Department Head | Samar Nahas |
| Supervisor | Sophia Ceron | Effective Date | 11/14/2022 |
Position(s) Directly Supervised
| Job Code | Title | FTE |
|---|
Department Custom Scope
| Reporting to both the department finance and administrative officer and the director of revenue cycle, the incumbent will contribute to our growth and success in meeting our mission by reviewing, analyzing, and assuring the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes inpatient and outpatient visits for hospital and office procedures for providers to ensure proper reimbursement. Provides education to the providers to ensure proper completion of electronic health records and proper assignment of International Classification of Diseases (ICD) 9/10, healthcare common procedure coding system (HCPCS), and current procedural terminology (CPT) codes. Enter and review daily charges, establishes cash quotes, and conducts provider education and training. |
Education & Experience Requirements
Education Requirements
Experience Requirements
| Experience | Requirement |
|---|---|
| A minimum of 1.5 years of acute hospital coding (HCPCS) experience with knowledge of CPT and ICD 9/10 coding and charge capture. | Required |
| Demonstrated skill/experience working with computerized reports to abstract information. | Required |
| Experience and knowledge of Neurosurgery, Women's Health (OB, Uro-Gyn, Gyn-Onc), and/or Orthopedics settings. | Preferred |
| Experience with M.D. Audit. | Preferred |
| Experience working in healthcare in an academic setting. | Preferred |
License Requirements
Certification Requirements
| Certification | Requirement |
|---|---|
| Current certification as a Professional Coder from the AAPC; ability to provide current documentation from appropriate agency. | Required |
Educational Condition Requirements
| Condition | Requirement |
|---|
Key Responsibilities
| Description | % Time |
|---|---|
| Medical Coding: 1. For inpatient and outpatient visits abstracts information from various chart documentation, dictated reports, electronic health records, encounter forms, hand-written progress notes and various other venues with the use of audit tools to reach appropriate CPT/ASA procedure codes, E/M (Evaluation & Management) codes and all other appropriate billing codes in compliance with University policies and government billing policies. Takes appropriate action if documentation does not support codes. 2. Analyzes and evaluates findings, diagnosis & procedure codes identified by physicians. Reports to supervisor, inconsistencies and/or incomplete charts, to inform the department and/or provider to improve billing/coding practices. 3. Uses sound professional coding judgment in establishing priority sequencing of diagnosis codes & services to assure maximum allowable reimbursement, consistent with but not limited to University Compliance Regulations, CMS Medicare & Medi-Cal, HMO, commercial insurance carriers and other related entities, and confirm that all codes/modifiers are appropriate. 4. Interacts with internal and external resources to facilitate all aspects of medical coding. | 50 |
| Enter and Review Daily Charges: 1. For inpatient and outpatient visits gathers demographic, insurance, and health care encounter information from a variety of sources for the purpose of billing medical provider professional fees. 2. Enter and verify the appropriate demographic information, charges, and comments into the computerized billing system. 3. Perform manual charge entry by gathering demographic, insurance, and healthcare encounter information from a variety of sources to accurately bill medical provider professional fees. 4. Ensure information entered in the system is done in an accurate and timely manner. Verifying charges on accounts as needed and providing detailed and accurate comments for future reference. 5. When necessary, create a registration in the appropriate system (EPIC) from documentation provided to accurately record encounter and accurately bill the appropriate payor. 6. Assist patients with inquiries regarding their bills or visits | 20 |
| Education and Training: 1. Maintains highly skilled technical knowledge through workshops, seminars, and classes aimed at educating coders with the most recent coding updates, techniques, and procedures for achieving correct and maximum reimbursement. Reviews documentation, such as bulletins, coding/billing subscriptions, publications, updates, and all other related coding resource materials. 2. Develops, recommends, and facilitates training for healthcare providers and staff on coding policies and procedures. | 10 |
| Cash Collection Reporting and Reconciliation (CCRRS): Follows up on high dollar charges, Establishes monthly patient activity reports, Cash collection-reconciliation -Price quotes & forms. | 10 |
| Other duties: Project management, administrative duties, and other tasks as assigned. | 10 |
Knowledge, Skills & Abilities
| Knowledge/Skill/Ability | Requirement |
|---|---|
| Comprehensive knowledge of federal, state and third-party-payer coding and documentation guidelines. | Required |
| Demonstrated ability to work independently with only general supervision. | Required |
| Organizational skills to prioritize workload and meet deadlines; develop and carry out project assignment in an efficient and timely manner. | Required |
| Working knowledge of Microsoft office software applications. | Required |
| Ability to interact in a professional and diplomatic manner with difficult and/or emotionally charged people. | Required |
| Comprehensive knowledge of medical diagnostic and procedural terminology with knowledge of anatomy, physiology, disease process and medical terminology. | Required |
| Excellent written and verbal communication skills to interact with tact and diplomacy with administration, physicians, and staff at all levels. Ability to generate error-free documents and correspondence. | Required |
Special Requirements & Conditions
| Special Condition | Requirement |
|---|---|
| Overtime | Required |
Other Special Requirements & Conditions
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Level of Supervision Received
| General Direction |
Environment
Working Environment
| Primarily office setting, but on occasion will work in a clinical setting. |
Other Requirements
Items Used
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Physical Requirements
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Mental Requirements
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Environmental Requirements
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Critical Position
| Is Critical Position: Yes |