MEDICAL CODER SPECIALIST

Duke Careers•Durham, NC

About The Position

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. Occ Summary The Medical Coder Specialist will have frequent and daily interactions with internal and external clients, including but not limited to physician and non-physician surgical providers. Responsibilities include primary diagnosis and procedural coding for the designated major surgical specialty areas and other major procedural areas, including capture of applicable Physician Quality Reporting System (PQRS) and reconciliation of all surgical cases performed at each hospital where applicable. The medical coder specialist focuses their work on the detailed physician surgical chart abstraction as well as being an immediate liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes for the providers in these areas. Surgical abstraction coding is defined as identification of codes based solely on the source documentation for CPT and ICD-10-CM, respectively.

Requirements

Extensive knowledge of coding surgical procedures and applicable modifiers in a multi-specialty setting.
Understanding and application of appropriate Center Medicare Services guidelines to coding.
Advanced ICD-10-CM & CPT-4 coding conventions.
Knowledge of Anatomy and Physiology.
Knowledge of Medical Terminology.
Extensive DRG/APC reimbursement knowledge.
Familiarity with coding software.
Effective written and verbal communication skills.
Data entry/CRT skills.
Bachelor degree in medical record administration or associate degree in medical record technology or one-year coding diploma or courses in medical terminology, anatomy & physiology with extensive training in coding.
Four years of coding experience, with at least two of those years in surgical abstraction (physician or medical group in multi-specialty surgical practices, i.e., cardiothoracic surgery, neurosurgery, general surgery, orthopedics, etc.).
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).

Responsibilities

Primary diagnosis and procedural coding for designated major surgical specialty areas and other major procedural areas.
Capture applicable Physician Quality Reporting System (PQRS) data.
Reconcile all surgical cases performed at each hospital where applicable.
Focus on detailed physician surgical chart abstraction.
Act as a liaison for documentation improvement and optimization of physician coding practices for compliance and revenue purposes.
Identify codes based solely on source documentation for CPT and ICD-10-CM.
Code from final surgical/procedural operative reports signed by the provider.
Review complex medical records and accurately code primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques.
Correlate information from approved supporting clinical documentation (pathology, radiology, physician consultations) after review by the attending physician.
Provide education/training to physicians and other providers on coding and clinical documentation.
Consult with and educate/train physicians on coding practices and conventions.
Communicate with nursing and ancillary services personnel for needed documentation.
Provide real-time feedback to surgical/procedural providers regarding proper coding and clinical documentation.
Serve as the primary liaison for clarification of documentation and coding for defined surgical operative cases, including documentation deficiencies.
Mentor and assist in the training of other coders within the department.
Participate in the development of coding policies and procedures.
Coordinate/mentor the work of designated coding employees through regular audits to ensure quality and quantity of work.
Assist with research and development of presentation materials for continuing education programs for physicians.
Provide high-level analysis of trends to management, Revenue Managers, and others about coding-related issues.
Research and identify trends in unbilled accounts.
Contact appropriate personnel for clinical documentation inefficiencies.
Coordinate quality reporting measures with providers and revenue managers/management (PQRS).
Collaborate with appeal and edit coders for expedient resolution of accounts.
Use authorized electronic media/systems for physician and non-physician clinician documentation, coding abstraction for each surgical procedure, and review of CCI edits, LCD and NCD coverage.
Perform other related duties incidental to the work described herein.