Medical Records Coder II-Commitment Bonus

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

 

About Duke Health's Patient Revenue Management Organization

 

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

 

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-10-CM 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 QC for vendor services for various HB and PB coding processes, including edits, denials, and charge capture.

·         Monitor and track outsourcing vendor performance as it pertains to QC and Productivity

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-10-CM and/or CPT, HCPCS coding conventions, and payer-specific coding guidelines.

·         Develop and assist with training, presentations, and educational tools 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, QA Team, Compliance Specialist, Internal Controls, Billing and Collections, and Revenue Managers) to ensure coding feedback to outsourcing vendors and the team is provided.

·         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 the department on coding practices and conventions 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 a 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 healthcare relevant changes.

·         Develop and maintain a thorough understanding of payer-specific guidelines as they pertain to edit review and validations

·         Develop and maintain a thorough understanding of payer-specific billing and coding requirements

·         Develop and maintain a thought understanding of CMS and the Palmetto Claim Processing Manual, including claim rejections.

·         Ensure active participation in any team event and departmental activities in the PRMO and DUHS

·         Ensure compliance with PRMO and DUHS policies and code of conduct

·         Assist with special projects as required

 

Medical Records Coder II –  Vendor Support – HB Edits

This is a progressive coder/auditor position, with opportunity for development and growth, accountable for key strategic vendor education and ensuring 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