Job Description

Professional Coder Sr TMC One
Job CategoryClerical
ScheduleFull time
Shift1 - Day Shift

SUMMARY:

Responsible for timely and accurate coding of administrative and clinical data through the assignment of  CPT-4, ICD 9, ICD 10, HCPCS codes while complying with the regulations and requirements of the Federal Government, State licensing agencies and corporate policies and procedures. Performs audits, data analysis, and reporting on data. Provides necessary mentoring and training for clinic and non-clinic staff.  Participates in quality review of organization’s physician practices and works closely with department managers on reporting functions and capabilities within the EPIC EMR system to meet quality care requirements.  Provides support in preparing and delivering training regarding coding and billing issues.

ESSENTIAL FUNCTIONS:

Exhibits leadership excellence through appropriate attitude, collaboration, and interaction with patients, visitors, and staff.

Assists physicians, providers and management in generating and managing records for all billable activities that take place within the organization.

Monitors physicians, providers, and medical staff by conducting monthly coding and record audits to ensure that they have sufficient information for accurate coding and to ensure that coding meets all compliance standards including departmental and official ICD-9, ICD-10 and CPT coding guidelines.

 Ensures all medical documentation for services provided has been signed/dated by the appropriate individual(s) and that the record is ready for medical billing within the appropriate timeframe.

Conducts ICD-10 annual documentation review for select patients scheduled for a clinical day and provides physicians and providers with a complete analysis prior to the clinic date.

Ensure physicians and providers complete patient’s assessment within medical chart. As needed, follow up with physician and provider to finalize the RAF and complete chart documentation.

Design and present educational aids and materials.

Maps out training plans, design and develop training programs.

Provide training sessions for internal subject matter experts including coders, Physicians, Nurse Practitioners.

Conducts organization wide needs assessment and identifies skills or knowledge gaps that need to be addressed.

Provides routine interaction with physicians, providers, and coding staff on a daily basis to assist with or resolve issues relating to medical documentation, coding, quality improvement, and clinical outcomes associated with patient care and service to ensure positive results.

Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact.

Assists in the development of programs and procedures to ensure a 96% or greater coding accuracy rate.

Prepares detailed reports that provide a range of data to assist management in evaluating performance and making recommendations.

Assists with Epic system analysis and report authorship and design.

Assists with analyzing business operations and provides recommendations for optimum EPIC system utilization.

Adheres to TMC/SPG organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  Completion of a two (2) year college or an equivalent combination of relevant education and experience.

EXPERIENCE: Three (3) years of related professional record coding experience. Preferred, two (2) to (3) years of business system analysis experience on an EPIC application.

LICENSURE OR CERTIFICATION:   American Academy of Professional Coders CPC required.

KNOWLEDGE, SKILLS AND ABILITIES:

  • Knowledge of medical terminology and coding related to professional billing such as, CPT-4 codes, ICD-9, ICD-10, and HCPCS codes.
  • Knowledge of medical insurance practices and policies and regulations
  • Knowledge of government and non government uniform coding and billing guidelines.
  • Knowledge of medical records and the evaluation of medical records for out-patient services.
  • Ability to maintain good working relationships and communication with the medical staff, nursing, administration and other ancillary departments with this organization.
  • Skill in preparing documents, reports, spreadsheets, graphs, presentations using computer application software Microsoft Office Word, Excel, Access, and PowerPoint.
  • Knowledge of system analysis and operating systems preferably used in an out-patient setting.
  • Skill in both verbal and written communications
  • Ability to resolve conflict using judgment, tact, and diplomacy.
  • Ability to write correspondence and effectively present information in one-on-one and small group situations to physicians, providers, and other employees of the organization.
  • Ability to prepare training materials and train staff in proper coding methods and techniques to ensure compliance with all federal and state regulations.
  • Ability to evaluate performance and make recommendations for improvement.
  • Ability to identify problems and recommend operations solutions.
  • Ability to analyze, interpret, prepare, and present reports to management.
  • Ability to accurately perform multiple tasks and observe strict deadlines.

Application Instructions

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