Coder Cardiovascular Svcs MHO in South Bend, Indiana at Beacon Health System

Reports to the Manager. Reviews, codes, and analyzes medical records for cardiovascular and interventional procedures performed in the cardiovascular/OR areas in order to abstract relevant data from patient medical records into the on-line computer system. Assigns CPT/APC billing codes to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code. Considered to be a single point of accountability to cardiovascular coding and billing.

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Maintains the single point of accountability function to cardiovascular coding and billing to ensure that all claims are submitted accurately to the payers by:

• Analyzing vascular surgery, interventional radiology and cardiovascular procedures.
• Checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient and inpatient records.
• Reviewing and monitoring pre-bill claims, manage bill edits, and monitor reimbursement post-remittance for cardiovascular billing area.
• Obtaining accurate and complete patient data through the review of the medical record, discharge summary, history and physical, consultation, progress notes, and laboratory, radiology, operative and pathology reports.
• Working with Record Management staff to code and assign billing codes for all procedures on inpatient records (all payors) and outpatient surgical records according to ICD-9-CM Codes, CPT-4 or Physician E&M (Evaluation & Management) Level Code (as applicable).
• Working with Physicians to resolve discrepancy issues between documentation and charges.
• Communicating with the Patient Accounts/Records Management staff and coordinating with department Manager any questionable abstract or coding problems.
• Reviewing and evaluating error messages and all incompatible DRGs/CPT's to the manager or coordinator for a second level review.
• Completing medical records for abstracting. Resolving any medical necessity related issues.
• Holding routine educational feedback sessions cardiovascular staff and physicians.
• Resolving all billing errors from scrubber edits.
• Performing post remittance reconciliations.
• Providing in-service charges to clinical staff responsible for charging.
• Reviewing a percentage of claims and compare charges submitted by the departments for accuracy against the physician report.

Completes medical record data entry duties by:

• Abstracting diagnosis and procedure codes into the Hospital computer system according to specified guidelines.
• Designating APC assignment on outpatient medical records.
• Assigning accurately, when applicable, a DRG or APC to Medicare, Medicaid and other required payor's records with the assistance of various computerized grouper software.
• Abstracting professional E&M codes, professional procedure codes, and technical component procedures into the Hospital computer system charging module according to specified guidelines.
• Accurate and timely entry of charges of cardiovascular charts according to guidelines if applicable.

Ensures accurate and up-to-date coding by:

• Educating Physicians and Staff.
• Auditing internal and external on a quarterly basis.
• Serving as a liaison with Patient Accounts and Medical Records.
• Attending ZHealth coding seminars and participate in ZHealth Publishing webinars.
• Remaining current on coding updates (available through ZHealth website access.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Completing other job-related duties and projects as assigned.

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma. The attainment of certification as an AAPC CIRCC, and maintenance of the certification within 18 months of obtaining the position is required. Three years of advanced medical and surgical coding experience is preferred or must be credentialed and experienced Heart and Vascular Technologist or cardiovascular nurse.

Knowledge & Skills

• Requires knowledge of medical terminology, anatomy and physiology necessary to code patient medical records utilizing established but specialized technical coding processes.
• Maintains knowledge in Heart and Vascular Technologist or Cardiovascular nursing (if applicable).
• Requires knowledge of the fundamentals of DRG/CPT assignment and optimization.
• Requires knowledge of state and federal regulatory guidelines for reimbursement in the prospective payment system in order to interface with physicians.
• Requires the analytical skills to compile and process patient information abstracted from patient records.
• Requires accurate keyboarding and understanding of the computer systems utilized within the department.
• Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact with staff, physicians, and others.

Working Conditions

• Works in an office environment.
• May experience some mental/visual fatigue from careful and constant review of records, code books, and continued use of computer equipment.

Physical Demands

• Requires the physical ability, motor coordination and stamina to perform the essential functions of the position.