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Job Summary:
A coder assists the Central Billing Office with analysis and review of various medical coding activities of NOMS Healthcare. This job includes collaborating with providers on coding decisions and other relevant point of service coding and documentation questions and inquiries. This job also includes conducting routine internal medical record audits and preparing compliance auditing reports. Audits include regular compliance medical records audits or focused review projects for ongoing review of coding and documentation for a variety of medical specialists to support compliance with coding and documentation rules and regulations.
Essential Functions:
1. Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
2. Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately recommend the appropriate assignment and sequence of correct ICD-10-CM and CPT codes.
3. Review all Medicare Wellness visit types to ensure all HCC codes have been added.
4. Reviews state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial.
5. Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees.
6. Makes recommendations for changes in policies and procedures; works with data processing staff to revise the computer master file. Develops and updates procedures manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
7. Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
8. Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
9. Educates and advises staff on proper code selection, documentation, procedures, and requirements.
10. Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection and coding of quality health data.
Competencies:
1. Knowledge of HCCs and impact on value-based contracts
2. Proficient in use of coding encoder software, electronic medical record software, Outlook, Excel, as well as other computer software programs.
3. Knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
4. Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
5. Ability to read and interpret medical procedures and terminology.
6. Ability to develop training materials, make group presentations, and to train staff
7. Ability to exercise independent judgment.
8. Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
9. Ability to maintain confidentiality.
Education and Work Experience:
1. 2-5 years of outpatient coding experience.
2. CPC or AHIMA Certification.
3. CPMA Certification preferred not required.
Certificates and Licenses Required:
1. Certified Coding Specialist
Environmental/Working Conditions:
Office setting, well-ventilated and well lighted. Work involves frequent telephone contact with patients. Work may be stressful at times. Interaction with others is constant and interruptive.
Physical/Mental Demands:
Normal office environment. Work is typically performed at a desk or table requiring the use of standard office equipment. Intermittent sitting, standing, and stooping. May view computer screen for long periods of time. Work may be stressful at times. Interaction with others is constant and interruptive.
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
NOMS is an equal opportunity employer committed to high standards of business conducted and civic responsibility. This includes our policy of offering fair and equal opportunities to every employee or applicant for employment regardless of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation) age, national origin, disability or genetic information, or status as a Vietnam-Era or special disabled veteran, or any other protected classes, in accordance with applicable law.
NHNPIJ
A coder assists the Central Billing Office with analysis and review of various medical coding activities of NOMS Healthcare. This job includes collaborating with providers on coding decisions and other relevant point of service coding and documentation questions and inquiries. This job also includes conducting routine internal medical record audits and preparing compliance auditing reports. Audits include regular compliance medical records audits or focused review projects for ongoing review of coding and documentation for a variety of medical specialists to support compliance with coding and documentation rules and regulations.
Essential Functions:
1. Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
2. Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately recommend the appropriate assignment and sequence of correct ICD-10-CM and CPT codes.
3. Review all Medicare Wellness visit types to ensure all HCC codes have been added.
4. Reviews state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial.
5. Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees.
6. Makes recommendations for changes in policies and procedures; works with data processing staff to revise the computer master file. Develops and updates procedures manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
7. Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
8. Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
9. Educates and advises staff on proper code selection, documentation, procedures, and requirements.
10. Identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the collection and coding of quality health data.
Competencies:
1. Knowledge of HCCs and impact on value-based contracts
2. Proficient in use of coding encoder software, electronic medical record software, Outlook, Excel, as well as other computer software programs.
3. Knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
4. Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
5. Ability to read and interpret medical procedures and terminology.
6. Ability to develop training materials, make group presentations, and to train staff
7. Ability to exercise independent judgment.
8. Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
9. Ability to maintain confidentiality.
Education and Work Experience:
1. 2-5 years of outpatient coding experience.
2. CPC or AHIMA Certification.
3. CPMA Certification preferred not required.
Certificates and Licenses Required:
1. Certified Coding Specialist
Environmental/Working Conditions:
Office setting, well-ventilated and well lighted. Work involves frequent telephone contact with patients. Work may be stressful at times. Interaction with others is constant and interruptive.
Physical/Mental Demands:
Normal office environment. Work is typically performed at a desk or table requiring the use of standard office equipment. Intermittent sitting, standing, and stooping. May view computer screen for long periods of time. Work may be stressful at times. Interaction with others is constant and interruptive.
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
NOMS is an equal opportunity employer committed to high standards of business conducted and civic responsibility. This includes our policy of offering fair and equal opportunities to every employee or applicant for employment regardless of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation) age, national origin, disability or genetic information, or status as a Vietnam-Era or special disabled veteran, or any other protected classes, in accordance with applicable law.
NHNPIJ
