This position facilitates modifications to clinical documentation through extensive concurrent interaction with physicians, nursing staff, other patient caregivers, and HIM coding staff to support that appropriate reimbursement and clinical severity is captured for the level of service rendered to all patients. This position reviews inpatient medical records while patients are still in-house for proper documentation; includes new admissions to the facility, as well as re-reviews periodically until the patient is discharged and is responsible for communication with clinicians and physicians to ensure timely and accurate documentation. This position provides training and education as needed. Individual will be responsible for the review of payer denials and participation in the appeal of clinical validation denials. This position receives regular supervision of work activities from the Mgr, Coding Compliance & CDI and does not provide direct supervision.
This position researches and codes all office, surgical and procedural-based reports/records by assigning accurate CPT codes, current version of ICD (diagnosis codes), HCPCS and modifiers in accordance with CMS coding guidelines and principles in a compliant manner.
This position researches and codes all office, surgical and procedural-based reports/records by assigning accurate CPT codes, current version of ICD (diagnosis codes), HCPCS and modifiers in accordance with CMS coding guidelines and principles in a compliant manner.
Under direct supervision of the Manager of Professional Services, performs audits of medical records for compliance with federal coding regulation and guidelines. Uses knowledge of PCH policies and procedures to provide a second level review of all Codes (CPT, EM, ICD-10 etc.) to achieve and maintain compatibility with Government and PCH billing requirements and compliance standards. This position collaborates with Coding Educator to provide training and education to Coding and Medical Staff. This position also assists with coding production, as needed; reviews and resolves coding issues related to billing; researches complex coding issues and participates in process improvements related to coding and EM management.