Professional Coding Specialist - Surgery (HSC)
Location: Morgantown West Virginia
Description: West Virginia University Hospitals is looking of Professional Coding Specialist - Surgery (HSC) right now, this occupation will be placed in West Virginia. For complete informations about this occupation opportunity please read the description below. Summary: Codes and abstracts all medical and demographic information for each patient record for the purpose ! of reimbursement, research and compliance with federal regulations. Researches and codes all diagnoses, operations, and procedures using the ICD-9-CM, CPT (including appropriate modifiers) or other specified classification systems, by utilizing UHDDS (Uniform Hospitals Discharge Data Set) guidelines. Analyzes and reviews records for completeness.
Essential Duties and Responsibilities: include the following. Other duties may be assigned.
1. Reviews and accurately interprets medical record documentation from all hospital accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the ICD-9-CM, CPT, and appropriate modifier codes for each diagnosis and procedure that is identified.
1.1. Review and interpretation should include, but not be limited to the following: staff notes, operative reports (written as well as those on the dictation system), medication administration! records, laboratory, x-ray, EKG, radiology and other ancillar! y pathology reports/post mortem examinations, respiratory therapy, physical therapy, dietary notes and nursing notes.
1.2. Appropriate coding materials such as Coding Clinic, CPT Assistant, etc. will be utilized to answer questions prior to making external queries. Other available medical and hospital references should also be employed (i.e., Merck Manual, Coder's Desk Reference, Dorland’s Medical Dictionary, Stedman’s Abbreviations, Faye Browne's Coding Handbook, etc.)
1.3. Pose questions concerning principal diagnosis, significant secondary diagnoses, Present on Admission indicator, and insufficient documentation to the attention of the attending physician via telephone, email or face-to-face encounter. The query responses will be documented by the physician in the medical record before coding and final billing. The Coding Specialist should also notate this information in the Merlin Account Notes section. Unresolved issues will be directed to the Lea! d Coding Specialist or Coding Manager.
1.4. Participates in educational training of new coding specialists and, at times, conducts training for WVU School of Medicine individual departments.
2. Enters information into the DRG/APC grouper for all discharges. Assures that accurate and timely coding and DRG/APC assignment has occurred for appropriate payers. This serves as a basis for review of anticipated hospital reimbursement and provides fiscal personnel and physicians with documentation of expected reimbursement.
2.1. Each discharged case or outpatient encounter is entered into the Merlin Coding Info Chapter. Correct identification of the attending physician should be made for all encounters. Correct identification of discharge disposition should be made for all encounters.
2.2. Each inpatient account with WVUH HIM’s top compliance related DRG’s should be reviewed by the Lead Coding Specialist to determine if appropriate coding has ! occurred. Those accounts with incorrect coding will be discussed with t! he Coding Specialists for appropriate re-education. These accounts will then be re-billed with new DRG assignment.
3. Assures that quality and timely coding, charging and abstraction of Interventional Radiology accounts are completed daily.
3.1. Daily identifies Interventional Radiology accounts via Merlin Coding work queues and reports.
3.2. Accurately assigns surgical and supervision & imaging (S&I) CPT codes for each Interventional procedure performed 95% of the time, as monitored through quarterly QA.
3.3. Enters all appropriate Interventional Radiology charges on each account via Merlin Charge Router.
3.4. Accurately assigns ICD-9 diagnosis and procedure codes in Merlin Coding Info Chapter for all outpatient patient types 95% of the time, as monitored through quarterly QA.
3.5. Enters additional comment in the Merlin Account Notes section as needed on inpatient accounts to notify other coders that the charging proce! ss is complete.
3.6. Removes appropriate “dummy Revenue Code 0899†charge from Merlin Charge Router upon selection of Interventional Radiology charge entry.
3.7. Monitors, updates and maintains all coding/charging issues on Merlin charging profile.
3.8. Communicates with Cardiovascular & Interventional Radiology Services Manager and WVUH Chargemaster Committee to identify/process new codes and charges as needed.
3.9. Participates in educational training/cross-training of new/existing Coding Specialists as needed.
4. Assures that quality and timely coding, charging and abstraction of Emergency Department accounts are completed daily.
4.1. Daily reviews/audits Emergency Department accounts for missing charges (medications/ injections/infusions/immunizations).
4.2. Communicates with Pharmacy for missing Medication charges.
4.3. Assures timely and correct charging of injections/infusions/immunizations f! or all Emergency Department accounts via Merlin Charge Router.
! 4.4. Accurately assigns Evaluation & Management CPT codes/charges for each Emergency Department account 95% of the time, as monitored through quarterly QA.
4.5. Accurately assigns Evaluation & Management CPT codes/charges for each Inpatient and Observation account that was admitted via the Emergency Department 95% of the time, as monitored through quarterly QA.
4.6. Accurately assigns ED CPT procedure codes & charges in Merlin Coding Info Chapter for all applicable Emergency Department accounts 95% of the time, as monitored through quarterly QA.
4.7. Accurately assigns ICD-9 diagnosis codes in Merlin Coding Info Chapter for all Emergency Department accounts 95% of the time, as monitored through quarterly QA.
4.8. Monitors, updates and maintains the Evaluation & Management System-wide Tool/Glossary in conjunction with United Hospital Center, Jefferson & City Hospitals as needed.
4.9. Communicates with the WVUH Chargemaster Commit! tee to identify/process new codes and charges as needed.
4.10. Participates in educational training/cross-training of new/existing Coding Specialists as needed.
5. Assures that quality and timely coding, charging and abstraction of other Outpatient accounts are completed daily.
5.1. Daily reviews/audits other Outpatient accounts for missing charges (medications/ injections/infusions/immunizations). Other outpatient accounts include, but are not limited to, Observation, Chemotherapy, Cancer Center, Peds Infusion, BMOP, and SDC.
5.2. Communicates with Pharmacy for missing Medication charges.
5.3. Assures timely and correct charging of injections/infusions/immunizations for all other Outpatient accounts via Merlin Charge Router.
5.4. Calculates Observation Hours based on established guidelines on all Observation and Observation to Inpatient encounters. Assigns correct Observation Hours charge to accounts via Merlin Charge R! outer. Assigns Direct Admit Charge based on established guidelines via ! Merlin Charge Router.
5.5. Accurately assigns ICD-9 and/or CPT procedure codes in Merlin Coding Info Chapter for all other Outpatient accounts 95% of the time, as monitored through quarterly QA.
5.6. Accurately assigns ICD-9 diagnosis codes in Merlin Coding Info Chapter for all other Outpatient accounts 95% of the time, as monitored through quarterly QA.
5.7. Communicates with the WVUH Chargemaster Committee to identify/process new codes and charges as needed.
5.8. Participates in educational training/cross-training of new/existing Coding Specialists as needed.
6. Assures that quality and timely diagnostic, procedural and other required data is coded, abstracted, and keypunched on all accounts. This information is submitted to Patient Financial Services to ensure accurate and timely billing for reimbursement.
6.1. The principal diagnosis and procedure are coded, sequenced and keypunched correctly 95% of the time, as moni! tored by peer quarterly QA.
6.2. Co-morbid conditions and complications that change the DRG/APC are correctly coded and sequenced in the top five diagnostic codes, 95% of the time, as monitored by peer quarterly QA.
6.3. Other conditions and complications are sequenced in the top nine diagnostic codes if appropriate, 95% of the time, as monitored by peer quarterly QA.
6.4. Accurate Present on Admission indicator is selected and entered in Merlin Coding Info chapter on all inpatient diagnoses 100% of the time. Diagnoses with an unknown POA indicator will be queried to the attending physician 100% of the time prior to completing the account.
6.5. All other diagnoses and procedures will be correctly coded and abstracted as appropriate, 95% of the time, as monitored by peer quarterly QA.
6.6. Procedures that will optimize hospital reimbursement are correctly coded and sequenced in the top three procedural codes 95% of the time, as mo! nitored by peer quarterly QA.
6.7. All other required data ele! ments will be abstracted and keypunched correctly 95% of the time, as monitored by peer quarterly QA. This shall include discharge disposition, procedure dates, responsible physician, birth weights (if applicable), and abstractor/coder name.
6.8. Coding Specialist must maintain a minimum overall coding accuracy rate each quarter of 95% or greater. Coding Specialists must maintain a minimum DRG accuracy rate each quarter of 98% or greater.
6.9. Applicable CCI edits are to be satisfied in Merlin work queues 100% of the time. Those charges that require a CPT code/charge to be modified or removed by an ancillary department are communicated to the appropriate personnel 100% of the time.
6.10. Applicable Medical Necessity edits are to be satisfied in Merlin work queues 100% of the time. Those charges that do not meet medical necessity due to lack of documentation require a comment in the Merlin Account Note section 100% of the time.
7. Maintain! s and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
7.1. All DRG change notifications from the PRO, or any third party payer with Quality Indicator changes are reviewed with the chart by each responsible coder, 100% of the time. Appeals should be made within 48 hours of the review.
7.2. Updates to ICD-9-CM codebooks will be inserted within one week of October 1st 100% of the time.
7.3. New CPT books are indexed and utilized by January 1 of each year, 100% of the time.
7.4. Attends all internal coding in-services/staff meetings, and at least one coding seminar yearly, if made available.
7.5. Reads and references all available coding publications such as Coding Clinic, CPT Assistant, National Correct Coding Institute, etc.
7.! 6. Researches new technologies, difficult procedures and unusual data v! ia physician discussion, textbooks, 3M Nosology, Internet List Service, etc. Code assignment and logic is recorded and distributed to all members of the coding team during the monthly in-service/staff meeting.
8. Each Coding Specialist is aware of and participates in Accounts Receivable (AR) reduction as it applies to the coding unit. Participates in case mix analysis.
8.1. Reviews daily Merlin reports for all patient types applicable to their coding duties. Reports are reviewed to determine the number of outstanding accounts, dollars and aging.
8.2. Participates in Performance Improvement of coding turnaround/Accounts Receivable (AR) reduction.
8.3. Sets team and individual goals for coding accounts on incomplete reports. Discusses plans, monitors backlog databases, and adjusts work based on the attainment of these goals.
8.4. Discusses and assists with time off and overtime schedules based on backlog numbers. (Time off is discu! ssed and granted based on backlog numbers.)
8.5. Each Coding Specialist monitors the incomplete backlog reports for their area of responsibility. Incomplete status is reported daily to the Coding Manager or Lead Coding Specialist. Problems are referred to the Lead Coding Specialist or Coding Manager after exhausting all known possible solutions. These possible solutions should include paging physicians, discussion with nursing personnel and tracking of charts in the usual locations. In case of a missing chart, the appropriate nurse manager should be notified immediately. Efforts to locate missing material are to be documented in the Merlin Account Notes section 100% of the time.
9. Maintains a knowledge base on compliance issues as they relate to coding and data quality.
9.1. Follows WVUH Standard of Ethical Coding Policy 100% of the time.
9.2. Assists Clinical Care Coordinators in the identification of observation patients.
9.3.! Assist Clinical Laboratories and Cancer Center on Medical Necessity La! b Regulations and educates Medical staff when possible.
9.4. Assists with improving physician documentation.
9.5. Assists/educates Quality Documentation Specialists with assignment of initial DRG/APR DRG’s. Attends QDP meetings as scheduled.
9.6. Notifies the appropriate Patient Access personnel of incorrect registrations.
9.7. Provides input and monitoring to ancillary services on correct modifier usage as well as CPT code assignment on the Charge Description Master.
10. Assures the accuracy and quality of data needed to obtain a clean bill prior to coding and completion of the abstract.
10.1. Reviews necessary admission information prior to coding, to ensure it is correct and complete. This would include at a minimum: patient identification, date of service and discharge disposition. Determine if there are duplicate/overlapping registrations. If information is incomplete or inaccurate, determine the correct data; not! ify the source and work to correct the problem.
10.2. Reviews charging information via Merlin Claim Edit work queues or Charge Router to identify items that are not documented such as procedures.
10.3. Review appropriateness of charges on accounts and suggests movement of charges based on documentation (late and lost charges).
10.4. Per Medicare and other third party guidelines, screens documentation for diagnoses that meets medical necessity for ancillary tests. Those charges that do not meet medical necessity due to lack of documentation require a comment in the Merlin Account Note section 100% of the time.
11. Monitors Patient Financial Service’s Quadex Billing System and Merlin Claim Edit work queues to facilitate in obtaining a clean bill, as assigned by Lead Coder or Coding Manager.
11.1. Reviews HIM Quadex and Merlin Claim Edit work queues daily.
11.2. Contacts appropriate Coding Specialist as needed to correct ! all accounts for CCI edits, Medical Necessity issues, missing diagnosis! /procedure information, interim bills and modifiers. Educates other Coding Specialists on these issues as needed.
11.3. Researches and answers questions posed by Patient Financial Services staff as needed.
11.4. Re-routes accounts to appropriate Patient Financial Services staff after resolution.
12. Maintains accurate productivity logs, time cards, and other related business reports.
12.1. Productivity database will be maintained daily 100% of the time. Productivity database should include type of charts coded, coding time, detail of miscellaneous time and any extraordinary occurrences. At a minimum, database entries are to be reviewed weekly and corrections reported to Coding Manager as necessary.
12.2. Vacation requests and appropriate PINC forms should be completely and accurately filled out prior to time taken off, 100% of the time. PINC forms are submitted to the Coding Manager for signature prior to time being entered into ! payroll system.
12.3. Coding Manager will review monthly and quarterly individual productivity statistics with each Coding Specialist.
Performance Standard: Adheres to the established Performance Expectations for WVUH Employees in the areas of People, Service, Performance Improvement, Shared Values & Culture.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Æ'á Ability to sit for long periods of time.
Æ'á Ability to lift, push or pull 11 20 pounds.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to en! able individuals with disabilities to perform the essential functions. !
Æ'á Standard office environment
Position Requirements
Minimum Qualification:
High school diploma or equivalent required and
Two years of medical coding experience required and Certification required at time of hire
Required:
If Certified Procedural Coder (CPC) certified, two years of experience in medical coding required.
If Registered Health Information Technician (RHIT) certified, one year of experience in medical coding required.
If Certified Coding Specialist â€" Physician Based (CCS-P) certified, no additional experience is necessary.
Preferred:
Previous clinical experience, as an RN, LPN or Medical Assistant, highly desirable and will substitute for medical coding experience. Previous medical office experience preferred.
Prior experience in medical coding desirable, will accept patient accounting/medical insurance billing experience. Knowledge of anatomy,! physiology and medical terminology required. Working knowledge of federal and state laws pertaining to medical billing and coding required.
Certification, Licensure
Certification, as follows, required at time of hire.
„P Certified Procedural Coder (CPC) or
„P Certification as Certified Coding Specialist--Physician-based or
„P Certification as Registered Health Information Technician (RHIT, formerly Accredited Records Technician (ART))
Continued employment contingent upon maintaining certification and mandated rate of accuracy. This position is required to maintain a 90% accuracy rate and is subject to random auditing of work performed.
Specialized Knowledge and Skills
Medical records and supporting documents must be analyzed for specifics regarding diagnosis, procedures and levels of daily care in order to optimize physician reimbursement without compromising any coding or Medicare regulation. Wo! rk is performed under tight time frames. Requires close attention to de! tail.
Medical terminology, anatomy, physiology, pharmacology course work or training required. Strong knowledge of Medicare billing regulations, general coding guidelines and UHA's Compliance Policy preferred.
- .
If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to West Virginia University Hospitals.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Mon, 03 Jun 2013 13:50:36 GMT