Coder 3 - Clinic

The Clinic Coder 3 abstracts clinical information from a variety of medical records, charts and documents and assigns appropriate codes to patient records according to established procedures. Assigns codes for specialty practices. Works with coding databases and confirms CPT assignments. Reviews and audits Physician Group provider medical records for documentation and coding compliancy and quality with federal and state laws and regulations. Familiar with standard concepts, practices, and procedures within a particular field. Relies on instructions and pre-established guidelines to perform the functions of the job. This position relies on guidelines and some experience and judgment to complete job and works under general supervision. Researches complex coding scenarios. Creates and presents coding education to clinical providers.

• Coding/Abstracting
• Determines the appropriate sequencing of diseases, diagnoses, and surgeries. Accurately assigns appropriate codes to patient records using applicable system(s), guidelines and regulations.
• Assigns codes for specialty physician practices.
• Assists the Business Office and external agencies in clarification of coding regarding reimbursement issues. Handles all requests in a timely fashion.
• Corresponds with other areas of the coding department to ensure the necessary components are available for accurate coding and the highest quality of the patient's medical record.
• Maintains an accuracy rate of not less than 90% based on internal and/or external review and a productivity standard per 8 hour day, engages in problem identification and solving, and assists in data gathering and chart auditing as necessary.
• Quality/Performance
• Researches, develops, and implements standardized processes for quality monitoring of coding and abstracting. Conducts high level quality audits for coding according to pre-established criteria in coordination with the Coding and Reimbursement Specialist. Assists Management with evaluation of functions and processes of the coding area to determine opportunities to improve the efficiency and quality of the coding area. Implements innovated ideas and process changes.
• Conducts and organizes provider meetings, provider peer reviews, and physician queries.
• Establishes and maintains interdepartmental relationships with providers to facilitate cooperation and compliance. Assists the Physician Group Revenue Management Department and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities of education and process improvement.
• Supports the auditing and education functions of the coding team. Performs audits on clinics in which they are assigned for production coding. Educates clinic staff on coding and documentation needs.
• Collaborates with management to identify and coordinate educational needs based audit results and new technologies. Provides support of monthly statistics and educational programs to staff on a regular basis. Provides technical assistance to IS staff authorized coding database retrieval and identification and resolution of software and system functionality.
• Creates reports to establish trends and benchmarking for coding standards by provider and or specialty in alignment with leadership and departmental needs.
• Other Duties as Assigned
• Attends meetings as required and strives to improve the quality of meetings by taking an active role in meeting topics. Participates in educational programs, in-services, and training sessions in an effort to share his/her own expertise with others and further the quality of education and personal growth provided to new personnel, volunteers, and interning students.
• Demonstrates competencies in the service to our patients/customers of all ages by obtaining information in terms of customer needs. Speaks in a positive, professional manner about co-workers, physicians, and the facility.
• Performs other duties as assigned or requested.
  
  

Experience - 5 years coding experience

Education - High School or equivalent

Special Skills - Solid oral and written communication skills, attention to detail, professional demeanor and appearance.