At Northbay Health, the Professional Surgical Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner for professional surgery charges in the outpatient and inpatient settings. The coder is dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines.
Primary Job Responsibilities
- The coder independently performs coding of patient's record to provide accurate physician, pro-fee and surgical billing and reimbursement while ensuring compliance. Codes all diagnoses and procedures according to the current classification system for the category of patient encounter.
- Responsibilities include collecting visit information, analyzing documentation and identifying discrepancies and querying providers as necessary ensuring the accuracy and integrity of all reviewed data.
- Utilizes the electronic health record/abstracting system/encoding/computer-assisted coding systems to carry out job functions.
- Ensure codes are accurate and sequenced correctly in accordance with coding guidelines and government and insurance regulations. Understands edit rules including those pertaining to assistant and co-surgeons.
- Abstracts designated demographic data into the medical record abstracting system to meet both internal and external regulatory requirements for reporting.
- Provides coding/documentation education to providers as needed to ensure coding practices are compliant with regulatory policies and requirements.
- Maintains department coding productivity and quality standards.
- Searches for information in cases where the coding is complex or unusual. Forwards unresolved coding questions to manager for review and comment.
- Keeps knowledge updated on coding requirements and compliance guidelines when required according to assigned specialty and departmental needs.
- Serves as a resource for coding/data issues for the organization.
- Provides timely feedback to the Manager, Professional Fee Coding, to identify operational issues. Escalates repeated and continuing problems to the Manager.
- Works with Business Office staff to resolve any billing/coding issues. Corrects all pending diagnosis or suspend report(s) as needed.
- Responds to audit reviews and addresses results in a timely manner.
- Keeps Manager and/or appropriate departments aware of completed work, backlogs, physician trainings and other assigned duties by utilizing tools provided for tracking.
- Maintains certification as a requirement of position. Enhances professional growth and development through educational programs, seminars, etc.
- Maintains and complies with HIPAA policies and procedure for confidentiality of allpatient records.
- Complies with North Bay’s Policies & Procedures, Safety Standards, TJC standards and other applicable regulatory statutes.
- Demonstrates the True North Values of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
- Reports into office as required and understands that if regulatory accuracy standards are not met, return to in-office work environment may be required.
- Performs other duties as assigned.