Certified Professional Coder

BASIC FUNCTION:

Incumbent reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid, and private insurance payments. Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

GENERAL RESPONSIBILITIES:

Abstracts all necessary information and sequences and assigns codes (ICD-10, CPT, and HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy/procedure according to established guidelines, and to identify secondary complications and co-morbid conditions.

Determines the final diagnoses and procedures as stated by the provider are valid and complete. Ensures documentation is complete to justify treatment and diagnoses.

Quantitative analysis – Performs a comprehensive review for the record to ensure the presence of all component parts such as: patient and record identification, signatures and dates where required.

Quantitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party reimbursement agencies and special screening criteria.

Analyzes documentation to ensure the appropriate evaluation and management (ER&M) levels are assigned using the correct CPT code.

Processes and accurately data enters assigned codes into the electronic health record and billing system; generates reports as needed to ensure completion. Follows up routinely on outstanding encounters that need to be coded.

Conducts chart reviews and audits for documentation reviews and provides feedback and education to clinical providers and other staff.

Serves as a coding subject-matter expert and provides answers to questions regarding coding and documentation.

Queries providers when documentation and diagnoses need clarification.

Attends mandatory staff meetings and in-services, including training to stay current in position and/or department.

Participates in quality assurance/improvement/control activities.

Follows all policies and procedures of the department, Seneca Nation, and Seneca Nation Health System.

KNOWLEDGE, SKILLS, & ABILITIES:

Advanced knowledge of diagnostic and procedural coding systems, medical terminology, abbreviations, minor medical procedures, anatomy and physiology, major disease processes, pharmacology, and the metric system.

Knowledge of official coding conventions and rules established by American Medical Association (AMA), and Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.

Knowledge of electronic health records systems.

Knowledge of Microsoft Office Suite, specifically Word, Excel, and Power Point.

Must have data entry skills.

Excellent verbal and written communication skills.

Knowledge of fiscal requirements, policy and procedures of federal, state, and tribal programs.

Recognize and respect cultural diversity.

Ability to prioritize and perform tasks.

Ability to maintain confidentiality of all patient protected information.

QUALIFICATIONS:

Associate’s Degree in Health Information Technology or Medical Coding.

Two years’ experience using ICD-10, HCPCS, and CPT is required.

Must possess and maintain current CPC, COC, CCS, CCS-P, CCA, RHIA, OR RHIT certification.

Must possess and maintain a valid NYS driver’s license.

Experience in a large hospital, academic medical center, outpatient health care setting, or Indian Health Service (IHS)/tribal health, preferred.