Clinic Coder

Description

The CPC Clinic Coder reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate codes for billing, internal and external reporting, research, and regulatory compliance. Under the direction of the Health Information Manager, inpatient and outpatient conditions and procedures are accurately coded as documented in the ICD-9-CM, ICD-10-CM Official Guidelines for Coding and Reporting published annually by the Centers for Medicare and Medicaid Serves (CMS) and the National Center for Health Statistics (NCHS), as well as by adherence to the coding policies and procedures established within this organization’s Health Information Management (HIM) department, and any applicable state laws. Adherence to the healthcare organization’s information privacy practices is also required.

The CPC Clinic Coder resolves error reports associated with the billing process, identifies and reports error patterns, and, when necessary, assists in design and implementation of workflow changes to reduce billing errors.  

Essential Functions: 

• Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for both inpatient and outpatient professional encounters.
• Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.
• Utilizes technical coding principals to assign appropriate ICD-9-CM, ICD-10-CM diagnoses and procedures on inpatient encounters.
• Utilizes technical coding principals and expertise to assign appropriate ICD-9-CM, ICD-10-CM diagnoses and CPT/HCPCS procedures.
• Assists in implementing solutions to reduce back-end billing errors.

Hospital Inpatient/Outpatient Coder.

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Assists with review of medical records of patients treated in the hospital setting for completeness per established documentation requirements.
• Notes deficiencies to be completed by physicians or other professional staff..
• Assigns appropriate codes for reimbursement purposes and to reflect the severity of services.
• Abstracts all patient encounters using the appropriate software application.

The preceding functions have been provided as examples of the types of work performed by employees assigned in this job classification. Management reserves the right to add, modify, change or rescend work assignments and to make reasonable accommodations as needed. 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skills and /or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Requirements

Education, Qualifications, Experience: 

• Two years direct coding experience and completion of a CPC and 2 years coding experience or an Associate's Degree in Health Information Technology. 
• Completion of anatomy and physiciology coursework with basic knowledge of anatomy & physiology, pharmacology and fundamental disease process.
• Successful passing of AHIMA’s CCA or CCS exam within 18 months of hire. 
• High school graduate. 

Initiative, tolerance, adaptability, motivated, positive regard for others, objectivity, self-assessment, analytical, flexible, able to interrelate with others, willing to learn, assumes responsibility, does not wait to be told what to do and how to do it, inquisitive, accepts individual challenges, adaptability, listens effectively, gives clear directions, good judgment and decision-making skills, ability to summarize, probe and clarify.

Knowledge, Skills, and Abilities: 

• Knowledge of coding rules and regulations.
• Attention to detail is vital.
• Meticulous with paperwork and proofreading.
• Able to handle repetitive work, work fast, work accurately under pressure, and motivated to work without close supervision.
• Ability to read and understand medical terminology, to read and understand written reports, and to abstract pertinent information from records.
• Clerical perception is required to spot pertinent details in material.