About the role
Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.
Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.
Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity.
Research electronic medical record for any additional diagnoses documented to meet medical necessity. Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements. Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to admission.
Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures. Conducts, audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing. Communicates with insurance companies about coding errors and disputes for physician billing.
Reviews and validates accuracy of data in Admission-Discharge-Transfer (ADT) fields following HIM coding policies and procedures. Reviews CRW (Certified Social Worker) documentation to assign correct discharge disposition, notify coding management when clarification needed. Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
Create electronic physicians’ queries within allowed scope for hospital outpatient coder. For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing.
Reviews chargemaster generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors. Makes appropriate coding corrections when advised and follows procedure to notify billing. For Professional Billing, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing.
Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding. Meets and maintains HIM coding quality and productivity standards.
Submits daily productivity report to HIM manager by defined deadline. Enhances and maintains coding knowledge and skills for physician billing. Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.
Competencies: ACCOUNTABILITY, ACCURACY - CODER, ACCURACY - OUTPATIENT, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTH INFORMATION MANAGEMENT (HIM) SYSTEMS - CODER, HEALTH INFORMATION MNGMT, MEDICAL RECORD CODING, MEDICAL TERMINOLOGY (1), PRODUCTIVITY - OP CODING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR Education and Certification
High School Diploma or Equivalent (Required)Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - State of Florida (FL), Registered Health Information Technician (RHIT AHIMA) - American Health Information Management Association (AHIMA) Additional Job Information: Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision.
Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills including Microsoft Office applications, computerized encoder, and electronic medical record systems. Ability to perform job duties using an electronic medical record system.
Requires a strong proficiency and understanding of Medical Terminology, Anatomy & Physiology, Pathophysiology and Pharmacology. Knowledge of coding classification systems and procedures. Possesses a strong foundation in coding and clinical knowledge with ability to review, research and code diagnoses and procedures with a high level of complexity.
Required Work
For HIM coder, two (2) years of hospital-based outpatient coding experience or a graduate of the internal MHS Coder Intern Program. For Physician Billing coder, two (2) years of higher complexities of diagnostic/procedural/office coding experience. Other Information: Additional Education Info: For HIM, completion of coding training program.
Additional Certification Info:For HIM: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS). For Physician Billing: Certified For Physician Billing, Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, Certified Coding Specialist (CCS), or Certified Coding Specialist - Physician Based (CCSP) by AHIMA.
Working Conditions and Physical
- Bending and Stooping = 40% Climbing = 0% Keyboard Entry = 60% Kneeling = 40% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non
- Patient = 40% Lifting or Carrying 2501 lbs - 75 lbs Non
- Patient = 0% Lifting or Carrying > 75 lbs Non
- Patient = 0% Pushing or Pulling 0 - 25 lbs Non
- Patient = 40% Pushing or Pulling 26 - 75 lbs Non
- Patient = 0% Pushing or Pulling > 75 lbs Non
- Patient = 0% Reaching = 40% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Running = 0% Sitting = 60% Squatting = 40% Standing = 60% Walking = 60% Audible Speech = 80% Hearing Acuity = 80% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Bio hazardous Waste = 0% Biological Hazards - Respiratory = 0% Biological Hazards - Skin or Ingestion = 0% Blood and/or Bodily Fluids = 0% Communicable Diseases and/or Pathogens = 0% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 0% Gas/Vapors/Fumes = 0% Hazardous Chemicals = 0% Hazardous Medication = 0% Latex = 0% Computer Monitor = 80% Domestic Animals = 0% Extreme Heat/Cold = 0% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 0% Potential Electric Shock = 0% Potential for Physical Assault = 0% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 0%
- Primarily for office workers - not eligible for shift differential Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954
- 276
- 8340 (M-F, 8am
- 5pm) or email TalentAcquisitionCenter@mhs.net