Under the general direction of the Coding and Clinical Abstracting Manager, this specialist is responsible for accurate coding of diagnosis and procedures for all observation, and outpatient surgery records, working from the appropriate documentation in the medical record of the patient. Classification systems include ICD-9-CM, ICD-10-CM, and CPT-4. The Coding Specialist III works with physicians and professional staff to obtain any necessary clarification concerning diagnosis and procedures, writing queries, charge referrals and medical necessity referrals as needed and according to facility guidelines. The Coding Specialist III is responsible for verifying, correcting, and posting charges and/or modifiers for designated service areas including observation, outpatient surgery, cardiac catheterization, endoscopy, interventional radiology, and infusions. He/She is responsible for monitoring the Discharges Not Final Billed (DNFB) list and plays an active role in meeting the organization’s financial goals. Possesses an understanding of OPPS, and APC reimbursement and the application of Local and National Coverage Determinations (LCD/NCDs). This person requires little supervision and performs all work independently, with a high degree of autonomy. All work is carried out in accordance with the department’s approved policies and procedures. This position is an advanced level technical position within the Coding Department.
1.Codes all diagnoses, treatments, and procedures according to the appropriate classification system for that category of patient encounter, and in accordance with provisions of the Uniform Hospital Discharge Data Set as well as the interpretation of these provisions as issued by the American Hospital Association and American Health Information Management Association and all governmental and private Third Party rules and regulations.
2.Abstracts patient information from records of all assigned accounts and enters appropriate data elements into the computerized abstracting system.
3.Verifies, corrects, and posts charge and/or modifiers for outpatient surgery, interventional radiology, cardiac catheterizations, observation hours, bedside procedures, injections and infusions, observation hours, and other designated service areas.
4.Consistently meets 100% productivity targets and quality requirements (95% or higher).
5.Completes continuing education required to maintain competency and credentials (as applicable) and to stay current with coding rules and guidelines.
6.Works with physicians and professional staff to obtain any necessary clarification concerning diagnosis and procedures, writing queries, charge referrals and medical necessity referrals as needed and according to facility guidelines.
7.Promotes customer satisfaction through prompt and courteous service.
8.Fosters respect for patient privacy by maintaining confidentiality in all phases of work.
9.Performs those duties necessary to ensure all accounts are processed accurately and timely.