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To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospitals, clinics and outside agency requirements. This includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record.



This position is an integral part of an overall compliance program effort as it pertains to hospital/physician coding and billing functions, as such will interact with physician and non-physician providers to maximize correct coding initiatives along with hospital coding. Responsible for analyzing and resolving issues of missing charges and problem accounts by researching information regarding department reimbursement. Responsible for the coding of the more complex patient classes i.e. inpatient, observations, same day care, etc. This position will be able to code a variety of patient classes along with This position will be responsible for Split Claim processes required for Critical Access hospitals.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified.  Assigns hospital and/or professional codes to a variety of patient classes (i.e. I/P, OBS, SDC, etc.)

2. Performs the coding/billing Split Claims process to ensure correct coding and reimbursement for appropriate accounts.

3. Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.

4. Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.

5. Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.

6. Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.

7. Monitors on an on-going basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.

8. Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment.

4. Must be Able to lift, push or pull 10-20 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Standard office environment.

2. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.

3. May require travel.

SKILLS AND ABILITIES:

1. Must be able to concentrate and maintain accuracy during constant interruptions.

2. Must possess independent decision-making ability.

3. Must possess the ability to prioritize job duties.

4. Must be able to handle high stress situations.

5. Must be able to adapt to changes in the workplace.

6. Must be able to organize and complete assigned tasks.

7. Must possess excellent written and verbal communication skills.

8. Must meet quality and productivity standards.

9. Must possess the knowledge of anatomy, physiology and medical terminology.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

548 SYSTEM HIM Coding Analysis