Medical Records Coder II, Vendor Support Services
HB-PATHOLOGY, AES, VENDOR SVCS
General Description of the Job Class
Coordinate/review the work of vendor outsourcing partners and assist with the training and continuing education programs. Code medical records utilizing ICD-9-CM/ICD-10CM and CPT-4 coding conventions. Review the medical record to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement professional charges. Abstract information from medical records following established methods and procedures.
Duties and Responsibilities of this Level
- Ensure quality and quantity of work performed through regular audits and Quality Control for vendor services specifically in the area of Hospital Facility, ASC Coding Denials
- Monitor and track outsourcing vendor performance as it pertains to Quality Control, Productivity and Process Improvement
- Be able to manage multiple Vendor’s Coding WQ by ensuring account prioritization while establishing outsourcing accountability
- Be able initiate, lead and follow through completion any special projects assigned to the Vendor Services
- Be able to work RTP (Return to Provider), FISS rejected claim and maintain WQ associated with the process.
- Review and research the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-9-CM/ICD-10 CM and/or CPT, HCPCS coding conventions and payer specific coding guidelines.
- Develop and assist training, presentations and educational materials for any relevant topic as it relates to continuing education programs on areas of specialization, coding, operational workflow and quality control.
- Collaborates with other departments and partners (e.g. Revenue Integrity, Compliance Specialist, Internal Controls, Billing and Collections, Revenue Managers, Health Care Administrators) to ensure coding feedback to outsourcing vendors and team are provided with adherence to best practice and controlling guidelines
- Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
- Consult with and provide feedback to physicians or department on coding practices and conventions in order to provide detailed coding information. Communicate with clinical, ancillary staff and revenue managers for needed documentation to ensure accurate coding.
- Develop and maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10 CM and CPT-4 coding guidelines to inpatient/outpatient diagnoses and procedures.
- Develop and maintain thorough understanding of medical record practices, standards, regulations, Health Care/Finance Administration (HCFA) and Uniform Billing (UB-04), CMS, and other payer policies and any health care relevant changes.
- Develop and maintain a thorough understanding of payer specific guidelines as it pertains to edit review and denial management.
- Ensure active participation in any team event and departmental activities in the PRMO and DUHS
- Ensure compliance to PRMO and DUHS policies and code of conduct
- Assist with special projects as required
Medical Records Coder II – Vendor Support
This is a progressive coder/auditor position, with opportunity for development and growth, accountable for key strategic vendor education and ensures coding accuracy for the vendor services. The ideal candidate has experience and knowledge in coding/billing, denials, payer guidelines as well as well-developed analytical skills in this area. The position is a forward facing role that will have regular access / communication to our coding vendor partners. Coding certification is required and additional certification for auditing is preferred.
- Quality Control – (40%)
- Review of vendor work to identify erroneous coding patterns and errors
- Providing feedback and education to vendor services to address issue found
- Monitoring and tracking of QC result
- Provide coding process analysis and support for the department as an expert for Outsourcing partner QC team and supervisors
- Vendor Education (30%)
- Plan activities aimed at improving the Coding Vendor’s quality performance in operations
- Design and implement strategies for enhancing vendor’s work quality and increasing productivity.
- Evaluate effectiveness of improvement strategy through sustained tracking and monitoring of vendor’s related WQ.Reporting of vendor specific trends and issues to upper management
- Coding (30%)
- Performing actual coding function to various coding WQs (i.e. charge review edit, coding denials and router WQs)
- Maintaining coding skill by continuing education and keeping abreast to regulatory healthcare related changes and payers
Requisition Number 300000229
Duke Entity PRMO
Job Code 4097 MEDICAL RECORDS CODER II
Job Family Level E2
Full Time / Part Time FULL TIME
Regular / Temporary Regular
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job 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.
High school diploma required. Bachelor is preferred.
RHIA certification- no experience required
RHIT certification- no experience required
CCS certification- one year of coding experience required
CPC or HCS-D certification- two years of coding experience required
Coding related function and/or Auditing experience preferred. Epic experience is a plus.
Knowledge, Skills, and Abilities:
- Effective written and verbal communication skills
- Ability to integrate Coding knowledge with Analytical Skill in solving complicated coding scenario and denials
- Ability to utilize available data to identify trends and workflow improvement
- Ability to communicate with customers/staff with diverse educational backgrounds
- Ability to provide feedback and education in a group setting or remotely
- Attention to detail and accuracy
- Ability to work independently and with a team
- Ability to initiate and complete projects as directed by departmental leadership
- Computer literacy
- Time management to be able to perform job function remotely and efficiently
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