MEDICAL CODER SPECIALIST

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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.

Occ Summary: The Medical Coder Specialist will have frequent and daily interactions with internal and external clients, including but not limited to physicians and non-physician surgical providers. Responsibilities include primary diagnosis and procedural coding for the designated major surgical specialty areas and other major procedural activities, including the capture of applicable Physician Quality Reporting System ( PQRS) and reconciliation of all surgical cases performed at each hospital where applicable. The Medical Coder Specialist focuses their work on the detailed physician surgical chart abstraction as well as being an immediate liaison to documentation improvement and optimization of physician codes of practice for compliance and revenue purposes for the providers in these areas.

Surgical abstraction coding is defined as the identification of codes based solely on the source documentation for CPT and ICD-9-CM, respectively. Primarily code from final surgical/procedural operative reports signed by the provider. Review the complex (problematic coding that needs review and reference checking) medical records and ICD-9-CM and/or CPTACCURATELY codes the primary and secondary diagnoses and procedures using coding conventions. 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-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures. Correlate information from approved clinical documentation, not limited to pathology, radiology, and/or other physician consultations, after review by the attending physician, wherever appropriate.

Provide education and 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 surgical and procedural 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. Mentors 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 the quality and quantity of work performed through regular audits. Assist with the search and development of presentation materials for continuing education programs for physicians in their areas of specialization. Interact with and provide a high-level analysis of trends to management,  revenue managers, and others about coding-related issues. Researches and identifies trends in unbilled accounts. Contact appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures with providers and revenue managers/management (PQRS). Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized electronic medical ia and systems for physician and non-physician clinician documentation, coding of extraction for each surgical procedure, review of CCI edits, LCD and N CD coverage.

Extensive knowledge of coding surgical procedures and applicable modifiers in multi-specialty settings understands and applies appropriate Medicare Services guidelines Advanced ICD-9-CM & CPT-4 codifying conventionsAnatomy and Physiology Medical Terminology. Extensive DRG/AP C reimbursement knowledgeCoding software familiarityData entry/CRTCode and abstract from Surgical Operative Notes while providing primary communication with specialty surgical providers in the health This individual will be an additional superuser as well as a float coder to support multiplication. The position will provide additional support for coders in their professional commutes and assist with re-establishing Coding Corner's monthly publications. The position will assist the coding supervisor(s) in auditing and QC on a monthly basis. This individual will assist in reviewing productivity and OER goals.

Minimum Qualifications

Education

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

Experience

It requires four years of coding experience, with at least two of those years in surgical abstraction (a physician or medical group in multi-specialty surgical practices, i.e., cardiothoracic surgery, neurosurgery, general surgery, orthopedics, etc.).

Degrees, licenses, and certifications

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

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

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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.