Coder Physician

Scope:

Experienced pro fee coder with a minimum of 5 years of experience in coding office, hospital and procedures for multi specialties.  Strong EM level of Service experience is a must. NCCI bundling experience/ appropriate use of Modifiers is a must. Experience multiple specialties to include at least some of  following Family Medicine, Internal Medicine, Dermatology, Orthopedics, Pediatrics, Cardiology and Gastroenterology.  Looking for someone very experienced and very comfortable moving across specialties. Free standing clinic services, with EM and office procedures included in the workflow. Point of Care testing, like EKGs, rapid strep, rapid A1C, tests included in workflow. Physical Therapy/ Occupational Therapy experience, that would be a bonus. Experience with Epic required.  Schedule can be flexible within reason after training.  The first week to 2 weeks will be between 8am and 4pm PST. 

Under the general direction of the Supervisor, incumbent performs abstracting of medical services provided by UCDHS and affiliates. Incumbent identifies all billable services, CPT-4,ICD-10, and HCPCS codes for billing purposes to government agencies, insurance companies and patients. Incumbent is responsible for the accuracy of above procedure and diagnosis coding relative to corresponding documentation and standards. Incumbent will ensure compliance to all federal, state and carrier specific rules, regulations and requirements related to professional fee services are adhered to. Incumbent will also act as a Subject Matter Expert to coding staff assisting with inquiries and questions. Incumbent will work with Supervisor in resolving identified coding issues and apply resolution with coding staff.

Summary/Objective 
Under limited supervision the Coder Physician reviews medical records and performs coding on all diagnoses, procedures, DRG/APC, and charge codes. The Coder Physician uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder Physician will be charged with maintaining the confidentiality of patient records and procedures. 

 

Essential Job Functions 

Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee, and clinical medical records. 

Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. 

Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes. 

Abstracts and codes pertinent medical data into multiple software programs and/or encoders. Follows official coding guidelines to review and analyze health records. 

Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. 

Extracts pertinent data from the patient’s health record and determines appropriate coding for reports and billing documents. 

Identifies codes for reporting medical services, procedures performed by physicians. Enters codes into various computer systems dependent upon the various clients. 

Track and document productivity in specified systems, maintain productivity levels as defined by the client. 

Maintain 95% quality rating 

Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. 

 

 

Key Success Indicators/Attributes 

Ability to prioritize and multi-task in a fast-paced, changing environment. 

Demonstrate ability to work in all work types and specialties. 

Demonstrate ability to self-motivate, set goals, and meet deadlines. 

Demonstrate leadership, mentoring, and interpersonal skills. 

Demonstrate excellent presentation, verbal, and written communication skills. 

Ability to develop and maintain relationships with key business partners by building personal credibility and trust. 

Maintain courteous and professional working relationships with employees at all levels of the organization. 

Demonstrate excellent analytical, critical thinking and problem-solving skills. 

Skill in operating a personal computer and utilizing a variety of software applications. 

Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes. 

Knowledge of JCAHO, coding compl