Medical Coder

Tohono O'odham Nation Healthcare•Tucson, AZ

3d•Onsite

About The Position

This position serves as a certified professional coder within Tohono O'odham Nation Health Care (TONHC). The role involves performing the full range of medical coding, assigning ICD, CPT, HCPCS, and inpatient codes, abstracting data, performing chart analysis, peer review, and acting as a technical expert for providers on medical documentation and coding. The work requires resolving problems using established processes, coding conventions, and guidelines, directly impacting patient care by accurately recording services performed. The incumbent works independently under general supervision.

Requirements

High school diploma or general education diploma
Medical Coding of Professional Medical Coder Certification, or closely related field
Three years of work experience in medical coding
Must type 40 WPM
Knowledge of the Tohono O'odham culture, customs, and traditions.
Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
Knowledge of computer software, including word processing, database, and spreadsheet applications.
Knowledge of legal regulations and requirements on confidentiality, specifically to the Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Thorough and detailed knowledge of and skill in applying health information management, medical records activities, and computerized data entry and retrieval systems.
Extensive knowledge of official coding conventions and guidelines established by the AHIMA, AHA, CMS, NCHS, etc.
Extensive knowledge of ICD/CM, and HCPCS, CPT appropriate Level coding.
Thorough knowledge and understanding of Diagnostic Related Group (DRG) and Ambulatory Patient Classification (APC) systems and associated encoding software applications.
Ability to abide by and promote compliance with the AHIMA Standards of Ethical Coding and with the Compliance Plan and Coding Compliance Plan of the TONHC Hospital and Clinics; and the Internal Control Policy of IHS.
Knowledge of the healthcare industry pertains to the functions of the position, capacity, and willingness to obtain continuing education required to maintain certification and stay apprised of changes in coding and the health care industry.
Thorough knowledge of pharmacology, including the ability to reference the Physician's Desk Reference (PDR).
Thorough knowledge of the RPMS software program, specifically the PCC, ADT, Scheduling, and EHR applications.
Knowledge and ability to use computers, scanners, and reference materials for day-to-day tasks within the hospital.
Thorough and detailed knowledge of and ability to conduct chart reviews and coding audits to ensure accuracy and appropriate coding and compliance with rules and regulations.
Ability to use standardized computer software such as spreadsheets, word processors, electronic email systems, and database software programs.
Skill and commitment to accuracy and detail.
Skill in providing superior customer service to external and internal customers.
Skill in operating various word-processing, spreadsheets, and database software programs.
Skill in organizational and office technology.
Ability to communicate effectively with others, orally and written.
Ability to prepare reports in a well-written, concise format using applicable software applications.
Ability to generate reports and analyze data from these systems.
Ability to establish performance improvement functions, track and report outcomes and conclusions or follow up orally and in writing.
Ability to organize and plan work.
Ability to deal with individuals from a variety of diverse backgrounds.
Ability to work independently, use sound judgment, and meet deadlines.
Ability to provide accurate reports.

Nice To Haves

May require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.
Upon recommendation for hire, a criminal background and a National FBI fingerprint check are required.
May require possessing and maintaining a valid driver's license (no DUIs or major traffic citations within the last three years).
If required, must meet the Tohono O'odham Nation tribal employer's insurance requirements to receive a driver's permit to operate program vehicles.
Based on the department's needs, incumbents may be required to demonstrate fluency in both the Tohono O'odham language and English as a condition of employment.

Responsibilities

Assigns codes to diagnoses and procedures using ICD, HCPCS, and CPT codes.
Reviews physician's patient medical documentation and determines the most appropriate corresponding code.
Performs the full range of coding per current ICD coding conventions and official coding guidelines.
Ensures codes are accurate and sequenced correctly per government and insurance regulations.
Reviews Electronic Health Record (EHR) data and ensures providers and other clinicians assign appropriate ICD codes.
Follows up with providers on insufficient or unclear documentation.
Assigns the appropriate CPT code for all outpatient medical, surgical, non-physician professional services, and diagnostic services.
Utilizes the CPT Assistant or other coding software to assist in the proper use of codes.
Assigns the appropriate HCPCS code for items, supplies, and non-physician services used in reimbursement claims processing.
Appropriately assigns modifiers to codes and verifies site, unit number, and location of services based on documentation.
Assigns and reports codes clearly and consistently supported by physician documentation.
Assists and educates physicians and other clinicians in proper documentation practices.
Establishes a working relationship with providers and consults physicians for clarification when necessary.
Works with computerized information systems, including EHR, encoding software, and the internet.
Maintains and enhances coding skills, staying abreast of changes in codes, guidelines, and regulations.
Abstracts and enters data for coding, billing, GPRA indicators, and governmental reporting processes.
Abstracts and enters data into a computer system for statistical purposes, third-party billing, and continuity of patient care.
Provides analysis of documentation and coding issues.
Assists with the formulation of query forms for providers.
Identifies inconsistencies within the medical record and participates in QA functions and peer reviews.
Participates in developing hospital and health centers coding policies.
Assists with technical issues within computer systems, including the EHR.
Assists in maintaining and updating ADT and PCC software packages.
Provides expertise and support in EHR development and maintenance of charge lists, pick lists, and templates.
Monitors and reports any discrepancies in the EHR regarding proper code assignments.
Ensures the quality of data in information systems by conducting audits and continuously analyzing data.
Attends meetings and serves as a resource person for coding.
Assists with coding and training of coworkers, providers, contractors, student interns, and other employees.
Serves as a resource for PCC data entry staff.
Contributes to a team effort and performs other job-related duties as assigned.