Full-Time

Medical Records Coder 2

Inpatient

Duke University

Duke University

No salary listed

Durham, NC, USA

Remote

Remote workers must reside in one of the listed states, including North Carolina.

Category
Medical, Clinical & Veterinary (1)
Required Skills
Medical Terminology
Requirements
  • A high school diploma is required.
  • Must hold one active/current certification: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Homecare Coding Specialist-Diagnosis (HCS-D).
  • RHIA or RHIT certification requires no experience; CCS certification requires one year of coding experience; CPC or HCS-D certification requires two years of coding experience.
  • Advanced knowledge of ICD-10-CM and CPT-4 coding conventions.
  • Knowledge of anatomy and physiology, medical terminology, and disease processes.
  • Extensive knowledge of diagnosis-related group and ambulatory payment classification reimbursement.
  • Familiarity with coding software.
  • Proficiency in data entry and CRT systems.
  • Effective written and verbal communication skills.
Responsibilities
  • Review complex medical records and accurately code primary and secondary diagnoses and procedures using ICD-10-CM and CPT coding conventions.
  • Coordinate and review the work of designated employees.
  • Ensure the quality and quantity of work through regular audits.
  • Assist with researching, developing, and presenting continuing education programs in areas of specialization.
  • Sequence diagnoses and procedures using coding guidelines.
  • Ensure diagnosis-related group and ambulatory payment classification assignments are accurate.
  • Abstract and compile medical-record data to support optimal reimbursement for hospital and professional charges.
  • Consult with and educate physicians on coding practices and conventions to provide detailed coding information.
  • Communicate with nursing and ancillary-services personnel to obtain documentation needed for accurate coding.
  • Maintain knowledge of medical-record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations requirements, Health Care Financing Administration requirements, and Medical Review of North Carolina requirements.
  • Maintain knowledge of anatomy and physiology, medical terminology, disease processes, and surgical techniques through continuing education.
  • Assist with special projects and perform other related duties.

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