Certified Professional Coder (CPC)

*This is a hybrid position, RI, MA, CT*

Job Summary:

Responsible for accurate coding of all Integra Community Care Network, LLC, and Women & Infants claims generated through inpatient services, outpatient services, outpatient professional services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record. Classification systems include ICD-9-CM/ICD-10-CM, ICD-10 PCS, CPT, HCPCS as well as other specialty systems as required by diagnostic category. All work carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic for HCPCS), and CPT Assistant published by American Medical Association /ICD-10-CM Official Guidelines, CPT-4 manual, HCPCS and CMS coding guidelines. As needed, Coders may assist and be a resource for data integrity for other employees who need clarification and assistance in coding. Coders may assist in education of Integra and Women & Infants staff who provide a reimbursable service.

Duties and Responsibilities:

Review medical records to identify diagnoses/procedures provided by the billing provider

Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems

Demonstrates knowledge of anatomy, physiology pharmacology and pathophysiology to interpret general medical classifications for coding discharge data.

Assigns Codes and codes all diagnostic and operative information from the medical record using ICD-10-CM, CPT, HCPCS coding classification systems and independently quality checks own work

Verifies and abstracts, all medical data from the record to complete a data abstract on each hospital encounter

Ensures that all data abstracted is consistent with guidelines outlined by JCAHO, and CMS, regional and local policy

Interacts with Integra Community Care Network, LLC and Women & Infants staff who provide a reimbursable service to the Integra Community Care Network, LLC members and Women & Infants patients, to clarify and accurately document patient diagnostic and procedural information

Enters patient information into the computerized inpatient and outpatient medical record databases

Ensures timely record availability by meeting established coding and abstracting productivity standards

Maintains and complies with policies and procedures for confidentiality of all patient records

Acts as an expert resource

Performs other related duties as assigned

Requirements:

High school diploma or GED required.

Must have at least three (3) years hospital inpatient, outpatient or surgical center coding experience within the last five years

Certification as a Certified Professional Coding Specialist (CPC)

5 years of compensatory experience

Completion of classes in medical terminology, anatomy and physiology, ICD-10 and CPT coding conventions, and disease process from an accredited program.

Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center—are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.