Some travel between Cranston and Zambarano Hospital but primarily located in Cranston. Expenses not reimbursed. Must use own vehicle and valid driver's license.
Facility does not have electronic medical records. Coders will be coding from paper.
In addition to standard submission requirements, PLEASE INCLUDE: Proof of Certificate of CCS by AHIMA or CPC through AAPC, and valid Driver's License.
GENERAL STATEMENT OF DUTIES: Review and evaluate in-patient and out-patient medical health
records to extract pertinent diagnostic, procedural and demographic information; ensure proper assignment
and maximization of financial reimbursement through proper interpretation and application of HCFA, ICD-10
IO-CM and CPT-4 rules and regulations, and the correct selection, sequencing and coding of diagnostic and
procedural information; accurately abstracts information; accurately abstracts information for inclusion in
financial, statistical and billing data bases; and to do related work as required.
ILLUSTRATIVE EXAMPLES OF WORK PERFORMED:
- To review, evaluate and correctly in-patient and out-patient medical records and extract
pertinent diagnostic, procedural and demographic information.
- To maximize financial reimbursement through proper interpretation and application of HCFA, ICD-
CM and CpT-4 rules and regulations.
- To maximize financial reimbursement through correct selection, sequencing and coding of diagnostic and
procedural information.
- To bring questionable or poorly documented cases to the attention of the physician of record, Medical
Records Director or Medical Director for discussion, clarification and resolution.
- To collaborate with and provide expert assistance to medical staff and medical records staff regarding
coding and other related issues.
- To work closely with billing unit staff to ensure appropriate internal control of data.
- To verify information on the PSI abstract form and review additional information recorded on the PSI
abstract form.
- To utilize computer systems in determining health care coverage for each patient.
- To ensure that health care records are coded, abstracted and forwarded to the billing unit for billing
purposes.
- To be responsible for maintaining a weekly "status" log of all admissions, transfer and discharges so
that all records aw accounted for and completed.
- To recognize the highly confidential information in a medical health record and understand the need for,
and importance of, maintaining strict confidentially of all patient and hospital information at all times.
- To assist supervisor and medical staff in other related work as requested.
KNOWLEDGES. SKILLS AND CAPABILITIES: An extensive working knowledge of medical
terminology, anatomy, physiology and pathology as well as a knowledge of pharmacology, diagnostic testing
and medical procedures sufficient to allow accurate interpretation of medical record content and
determination of precise diagnoses and procedures; a complete working knowledge and understanding Of
ICD-10-CM and CPT-4 classification systems and demonstrate proficiency in the application of coding rules
and regulations; knowledge of Medicare, Medicaid and other third-party payors; regulations and policies
regarding billing and reimbursement, the ability to apply such knowledge for extracting and assigning proper
codes for billing purposes; ability to provide guidance, direction and assistance when needed to medical staff,
medical records staff and billing unit staff; and related capacities and abilities.
EDUCATION AND EXPERIENCE:
Education: Such as may have been gained through graduation from a college of recognized standing with
specialization in medical record science; or graduation from a school of nursing, and certification as an
CCS by AHIMA or CPC through AAPC.
Experience: Such as may have gamed through employment as a Coding Abstractor or Coding
Specialist and working with the CPT-4 classification system in the reimbursement area in an approved public
or private hospital.
Or, any combination of education and experience that shall be substantially equivalent to the above education
and experience.