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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 areas, including the application of the applicable Physician Quality Reporting System (PQRS) and confirmation 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 coding practices for compliance and revenue purposes for the providers in these areas. Statistical abstraction coding is defined as the identification of codes based solely on the source documentation for CPT and ICD-10-CM, respectively.
Work Performed
Primarily code from final surgical/procedural operative reports signed by the provider. Review the complex (problematic IC coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using IC D-10-CM and/or CPT 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-10-CM 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 and training to physicians and other providers on coding and clinical documentation.
Consult with and educate/train physicians on coding practices and conventions to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to surgical/procedural providers as it pertains to proper coding and clinical documentation of services performed. Engage in practitioner/department contact and education as the primary liaison to clarification of documentation and coding for defined surgical operative cases, including documentation deficiencies. Mentor and assist in the training of their 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 research and development of presentation materials for continuing education programs for a physician in their areas of specialization. Interact with and provide a high-level analysis of trends to management, managers, and others about coding-related issues. Researches and identifies trends in unbilled accounts. Contacts appropriate personnel for clinical documentation inefficiencies. Coordinate the quality reporting measures with providers and revenue managers/managers (PQRS). Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized electronic media/systems for physician and non-physician clinician documentation, coding abstraction for each surgical procedure, review of CCI edits, LCD, and NCD coverage. Perform other r elated duties incidental to the work described herein.
Knowledge, Skills, and Abilities
Extensive knowledge of coding surgical procedures and applicable modifiers in multi-specialty settings. Understands and applies appropriate Center Medicare Services guidelines tocodingAdvance d ICD-10-CM & CPT-4 coding conventionsAnatomy and PhysiologyMedical Term inologyExtensive DRG/APC reimbursement knowledgeCoding software familiar effective written and verbal communication skills data entry/CRT.
Level Characteristics
Code and abstract from Surgical Operative Notes while providing primary communication with specialty surgical providers in the health system.
Minimum Qualifications
Education
Bachelor's degree in medical record administration or associate degree in medical record technology or one-year coding diploma or courses in Medical Terminology, Anatomy & Physiology with extensive training in coding.
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, licenses, and certifications
Registered HealthInformation Administrator (RHIA), Registered Health Information Technician (RHIT), 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.
