Reviews, interprets, and codes surgical medical records for reimbursement purposes using ICD-10-CM standards. Reviews operative reports for all procedures performed by Excelsior Physicians for completeness and to abstract and code clinical data, using standard classification systems. Operates computer to process, store, and retrieve health information.
Duties and Responsibilities
Audits accuracy of ICD-10-CM diagnosis codes on all claims prior to submission.
Audits accuracy of HCPCS and CPT codes on all procedures and services performed prior to submission. Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
Receives hospital information to properly bill provider services for hospital patients.
Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.
Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
Contacts providers to train and update them with correct coding information.
Attends seminars and in-services as required to remain current on coding issues.
Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
Performs other related duties, which may be inclusive, but not listed in the job description.
Requirements and Qualifications
Podiatry or Physiatry coding experience desired
Current medical coding certification.
Surgical Coding preferred.
Orthopaedic, pain management, and physiatry coding experience preferred.
Proficiency with a minimum of one (1) year experience in EMR and practice management computer programs.
Knowledge of orthopedic, physical therapy, and/or podiatry medical terminology preferred.
Medent EMR experience preferred.
Physical Demands
Position requires manual and finger dexterity and hand-eye coordination.
Involves standing and walking.
Team member will occasionally be asked to lift and carry items weighing up to 30 pounds. Normal visual acuity and hearing are required.
