RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

• Reviews participant medical records to ensure complete and accurate information
• Reviews medical staff documentation to ensure consistency and completeness
• Extracts principal diagnosis and procedures information utilizing current Medicare coding guidelines and other supporting references
• Enters codes into reporting database. Codes ancillary outpatient and inpatient hospital encounters using ICD-10 CM. Maintains the highest percentage of accuracy as possible and monitors personal audit results from independent coding auditor
• Reviews coding reports to ensure ongoing diagnoses are appropriately documented and follows up with providers regarding dropped Hierarchical Condition Categories (HCC) and documentation requirements
• Analyzes reports for errors/irregularities and identifies root causes of error in order to prevent future coding errors
• Analyzes reports to monitor both favorable and unfavorable trends over time and brings the data analysis to supervisors attention for discussion and remediation
• Obtains and prepares data for periodic/special reports, as requested
• Maintains a positive and productive working relationship with coding consultant(s) in order to gain organization-specific guidance and coding knowledge
• Stays current in changing Medicare regulatory environment and requirements
• Assists Accounting staff with month-end activities, as requested
• Participates in projects related to year-end and other audits as needed
• Actively participates in Health Information Management team meetings and special projects to ensure the team successfully meets its strategic goals

ORGANIZATIONAL (CORE RATING FACTORS):

• Demonstrates support of the Companys Mission, Vision and Core Values
• Provides Exceptional Customer Service
• Ensures discretion with confidential information in accordance with HIPAA guidelines
• Supports a collaborative work environment including courteous, helpful and professional behavior
• Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
• Adheres to and supports all Company policies and procedures
• Supports and practices safe work habits in accordance with policies and procedures
• Brings ideas, problems and concerns forward and participates in resolution and implementation
• Participates in and completes regulatory compliance trainings within the prescribed deadlines
• Attends required meetings
• Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency

QUALIFICATIONS AND REQUIREMENTS:

• H.S.Diploma or equivalent required
• Minimum 7 years experience with medical coding and familiarity with medical terminology is required.
• Medicare and Medicaid coding experience with a working knowledge of compliance, federal and state rules and regulations required
• Minimum 3-5 years experience with electronic health records systems required
• Associates degree in a related field preferred
• CPC- Certified Professional Coder or CCS-P through AHIMA required within 6 months of hire
• Risk Management coding experience preferred

PHYSICAL DEMANDS AND WORKING CONDITIONS:

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

Physical Requirements This job operates in an office environment and is largely a stationary position (over 50% of the time), however, some filing is required. This requires to the ability to move files, filling out paperwork and bending/standing as necessary. Operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer for nearly the entire work-day. Requires the ability to read paperwork, computer screens and communicate effectively through use of verbal and/or written forms. This role often is required to position oneself in a kneeling, bending, or crouching position to reach, install, or remove computer equipment. Requires the ability to move boxes, files, supplies/equipment, etc. up to 15 pounds using appropriate body mechanics.

Environmental Conditions This role operates in a closed office environment. Work-space may be shared. Working conditions may be noisy with fluctuating indoor temperatures. May be exposed to a risk of bodily injury through contact with moving instrumentation, substances and other conditions common to an office environment. This job requires working under stressful conditions. Moderate pressure to meet scheduled and recurring deadlines.

REPORTS TO: Medical Coder II

FLSA Status: Non-Exempt

Qualifications

QUALIFICATIONS AND REQUIREMENTS:

• H.S. Diploma or equivalent required
• Minimum 7 years experience with medical coding and familiarity with medical terminology is required.
• Medicare and Medicaid coding experience with a working knowledge of compliance, federal and state rules and regulations required
• Minimum 3-5 years experience with electronic health records systems required
• Associates degree in a related field preferred
• CPC- Certified Professional Coder or CCS-P through AHIMA required within 6 months of hire
• Risk Management coding experience preferred