Medical Coder Specialist

PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.

General Description of the Job Class

The Medical Coder Specialist will have frequent and daily interactions with internal and external clients including but not limited to Physician and Non-physician Cardiology CATH/EP Surgeons. Responsibilities include diagnosis and procedural coding for the designated major surgical specialty areas and other procedural areas including the capture of professional services provided and reconciliation of all surgical or procedural cases performed at each hospital where applicable. The Medical Coder Specialist focuses their work on detailed physician procedural chart abstraction as well as serves as a liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes. Surgical and/or procedural abstraction coding is defined as code assignment based solely on the source documentation for C PT –4 and ICD-10-CM respectively.

Duties and Responsibilities of this Level

Primarily code from final procedural/ surgical operative reports signed by the provider. Review complex medical records and accurately assign codes for primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT-4 coding conventions. Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and procedural/surgical techniques through participation in continuing education programs to effectively apply ICD-10-C M and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures. Correlate information from approved supporting clinical documentation not limited to Pathology, Radiology, and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.

Provide education/training to physicians and other providers on coding and clinical documentation. Consult with and educate/train physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to procedural/surgical providers as it pertains to proper coding and clinical documentation of services performed. Engage in provider/ department contact and education as the primary liaison for clarification of documentation and coding for defined surgical operative cases including documentation deficiencies.

Mentor and assists in the training of other coders within the department. Participate in the development of coding policies and procedures as identified. Coordinate/mentor the work of designated coding employees to ensure quality and quantity of work performed through regular audits. Assist with research and development of presentation materials for continuing education programs for physicians in their areas of specialization.

Interact with and provides high-level analysis of trends to Management, Revenue Managers, and others about Coding related issues. Researches and identifies trends in unbilled accounts. Contacts appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures w/ providers, revenue managers, and management. Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized resources and systems to aid in accurate code assignment for physician and non-physician documentation and surgical abstraction. This may include but is not limited to a review of NCCI Edits, LCD’s, NCD ’s, use of nThrive, and other reputable coding references

Perform other related duties incidental to the work described herein.

Minimum Qualifications

Education

A minimum of a high school diploma and AAPC or AHIMA coding credential(s).

Experience

Requires four years of coding experience, with at least two of those years in surgical abstraction(physician or medical group in multi- specialty surgical practices, i.e., Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.).

Degrees, Licensures, Certifications

Registered Health Information Administrator(RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)

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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob 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.