The Clinical Coder is responsible and accountable for reviewing medical record documentation and assigning codes for reimbursement and statistical purposes.
Dependent upon level of expertise defined in the Education/Training section:
Maintains a working knowledge of coding fundamentals: ICD-9-CM coding for inpatient, outpatient, and/or physician services; HCPCS coding, namely CPT-4 for surgical procedures, for outpatient and/or physician services; and/or HCPCS coding, namely Evaluation and Management, for physician services.
Maintains a working knowledge of coding guidelines: Official Guidelines for Coding and Reporting, American Hospital Association’s Coding Clinics, and/or American Medical Association’s CPT Assistant.
Maintains a working knowledge of reimbursement as it relates to coding: the government prospective payment systems for inpatient, outpatient, and/or home health agencies, skilled nursing facilities, inpatient rehabilitation as well as other third party medical billing requirements.
Assigns codes based on medical record documentation and seeks further clarification from physicians when documentation is unclear, illegible, or conflicting.
Achieves and maintains a high level of accuracy and productivity in coded claims.
Maintains a working knowledge of coding compliance.
Works in conjunction with the Business Office to reconcile denied claims due to coding issues.
Maintains a working knowledge of the HBOC and 3M system.
May perform some coding audits for quality checks.
May do some physician education.
Performs other related duties as assigned.
EDUCATION, TRAINING REQUIREMENT:
Dependent upon level of expertise defined in the Addendum:
Must possess two (2) years of coding experience.
Certified Coding Specialist (CCS) approved by the American Health Information Management Association (AHIMA) for inpatient or hospital outpatient coding.
Bachelor or Associate degree and successful completion of the examination for Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) approved by AHIMA for inpatient or hospital outpatient coding.
Certified Procedural Coder- Hospital (CPC-H) approved by AAPC for hospital outpatient coding.
Certified Coding Specialist- Physician (CCS-P) approved by AHIMA for physician services coding.
Certified Procedural Coder (CPC) approved by the American Academy of Professional Coders (AAPC) for physician
See Addendum for experience specifications.
Excellent communication and writing skills required.
Near visual acuity required to read charts. Must be able to hear and communicate on the telephone. Some travel may be required.
All applicants for the Clinical Coder position must take and pass coding tests
administered by ARH prior to hiring. The coding test also consists of coding directly from sample patient charts.
POSITION PHYSICAL REQUIREMENTS
Must possess physical ability to endure prolonged sitting; moderate walking; lifting and carrying. May require exerting up to 20 pounds of force occasionally; and/or up to 10 pounds of force frequently; and/or a negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for sedentary work.
Accountable for accurately assigning codes according to official coding guidelines and ARH coding guidelines.
Accountable for assigning the correct payment classification.
Accountable for attending educational seminars on coding to maintain continuing education requirements.
Accountable for communicating with the medical staff for additional information to complete the coding process.
Accountable for performing duties and responsibilities in accordance with the ARH Coding Compliance Program.