Performs technical and administrative work reviewing, abstracting, and assigning accepted medical CPT, HCPCS, and ICD-10 codes for professional services. Duties are performed in compliance with third-party, state, and federal regulations according to standardized procedures. Employees report to an administrative superior but independently handle assigned tasks.
Responsibilities
- Assign ICD-10-CM diagnosis codes accurately and productively.
- Assign diagnosis codes for chronic conditions documented that may impact HCCs or expected mortality.
- Assign HCPCS and CPT codes accurately and productively.
- Group codes and completed work into payment groups and analyze information for optimal reimbursement.
- Review NCD, LCD, and CCI edits, apply coding changes appropriately, and add modifiers when needed.
- Recognize medical necessity requirements and resolve edits during code assignment.
- Ensure compliance with coding, billing, and data collection regulations and procedures.
- Provide coding guidance to physicians and other healthcare staff regarding current practices and regulatory changes.
- Review, analyze, and abstract physician and other documentation for diagnoses, procedures, and services provided.
- Obtain missing information and clarify existing information when needed.
- Accept feedback from auditors to help prevent future errors.
- Research appropriate databases to validate information.
- Use software such as Epic, Optum CAC, and MS Office to compile and validate medical information.
Requirements & Qualifications
Education
- High school diploma or GED required; a higher-level degree may satisfy this requirement.
- Successful completion of the UNC HCS Hospital Outpatient Coder Proficiency Test.
Certification
- Must have AHIMA certification/credential or AAPC certification/credential.
Experience
- 12 months of experience in hospital coding.
Knowledge and Skills
- Strong knowledge of ICD-10-CM and HCPCS/CPT coding.
- Strong analytical and data mining skills.
- Ability to effectively manage projects.
- Ability to work effectively with staff at various levels, including on-site and remote.
- Strong written and verbal communication skills.
- Strong attention to detail.
- Strong organizational skills and time management.
- Ability to manage multiple priorities.
- Ability to interpret moderately complex medical conditions and work with complex coding applications.
- Ability to balance high productivity with high-quality work.
- Ability to interpret federal and state regulations related to coding and compliance.
Location
North Carolina, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago