*Now offering a $5,000 commitment bonus that will pay out in 2 equal installments over 12 months in 6-month increments.
Certified coding position supports coding denials and edits processing for Coding Operation - Medicine Team.
- Coding Denials Processing (40%) - Processes coding related edits that support defined specialty area(s)
- Review of Denials Reason code to identify nature of denials.
- Review and update coding of ICD-10-CM and CPT-4 as it pertains to Correct Coding Initiative (CCI), Local/National Coverage decisions (LCD/NCD) and other payer's specific edits and denials.
- Sequence the diagnoses and procedures using coding guidelines.
- Identification of denial trends to ensure charge capture and coding edits are prompted appropriately and that provider charge capture education material is created to ensure performance improvement of coding process.
- Perform or initiate appropriate changes to patient account necessary to ensure appropriate coding and compliance w/ payer regulations to include the rebilling of appropriate claims. Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
- Charge Review Resolution (40%) -
- Review of error reason to identify accuracy and nature of edit.
- Review the complex (problematic coding that needs research and reference checking) Medical Records and accurately code the primary/secondary diagnoses and procedures using ICD-10 CM and/or CPT-4 coding conventions
- Using coding expertise and available resources, arrive at a coding decision to clear/resolve error(s).
- Implement coding decisions based upon current ICD-10 CM and CPT-4 guidelines, as well as payor and/or DUHS corporate compliance policies and procedures.
- Document comments to support coding decision/action.
- Manage WQ volumes, identifying any trends or unusual activity.
- Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
- Customer Service (10%) - support Customer Service in response to patient inquires around coding issues
- Review of inquiry.
- Identification of coding related issue based on combination of inquiry, denials information and documentation of services performed.
- Response to Customer Service including supporting notation to provide timely and appropriate response to patient.
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- Denials/Edit Trending (10%) -review denial and edit/error information for defined specialty area(s) and identify trends for overall process improvement
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position.
Employees may be directed to perform job-related tasks other than those specifically presented in this description.
o Assist with research, development and presentation of continuing education programs on area(s) of specialization
Required Qualifications at this Level
Education: High school diploma required.
Experience: CCS certification- one year of coding experience- Required
CPC certification- two years of coding experience -Required ICD-10 Certification of Proficiency- Required
Must hold one of the following active/current certifications in addition to ICD-10 Proficiency Certification:
AHIMA Certified Coding Specialist (CCS/CCS-P) Hospital or PB Coding
AAPC Certified Professional Coder (CPC)
Advanced ICD-10-CM & CPT-4 coding conventions Anatomy and Physiology
Medical Terminology Coding software familiarity
Payor Guidelines and Billing Procedure Knowledge Professional written and verbal communication skills EPIC /EMR Experience
Distinguishing Characteristics of this Level
Must hold one of the following active/current certifications: Registered Health Information Administrator (RHIA) Hospital Coding Registered Health Information Technician (RHIT) Hospital Coding Certified Coding Specialist (CCS) Hospital Coding Certified Professional Coder (CPC) Homecare Coding Specialist-Diagnosis (HCS-D) Homecare Coding
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.