Analyzes medical records to ensure accurate sequencing and assignment of ICD-10-CM and CPT-4 codes, confirms appropriate DRG assignment, communicates with physicians for documentation clarification, abstracts and enters medical record data for statistics and reporting, and supports the Business Office with timely billing of patient information.
Responsibilities include:
- Review medical records to determine ICD-10-CM and CPT-4 codes in accordance with coding and reimbursement guidelines.
- Verify abstracted data and accurately enter clinical information to maintain database integrity.
- Apply UHDDS standards for principal diagnosis, principal procedure, complications, and comorbid conditions.
- Review unbilled accounts daily and make necessary coding adjustments.
- Review case mix reports weekly and follow up on records requiring re-review.
- Participate in coding and abstracting quality reviews.
- Assist physicians with coding versus clinical documentation issues.
- Support other coders with coding questions and escalate to the Unit Leader as needed.
- Contact physicians for clarification when necessary.
- Complete interim billing for rehabilitation and transitional care unit patients as requested.
- Meet or exceed departmental quality and quantity standards.
- Follow policies, procedures, and safety standards while supporting quality improvement initiatives.
Minimum education: None specified; an equivalent combination of education and/or work experience sufficient to demonstrate the required knowledge, skills, and ability is acceptable, typically equivalent to an associate degree. Preference may be given to candidates with an associate degree in a directly related field.
Minimum experience: Previous coding experience preferred.
Licensure/certification preferred: RHIA, RHIT, or CCS.
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago