Job Description

Coder Analyst Specialist, Clinical Doc Integrity

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group Overview:

Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, our team delivers expertise across a broad spectrum of specialties from primary care and walk-in clinics to preventive medicine and advanced surgical and subspecialty services. We are committed to offering coordinated, patient-centered care that spans the continuum of health needs, ensuring access to exceptional providers close to home.

Analyzes documentation in the medical record to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and CPT-4 codes. Abstracts and codes procedures in conjunction with the provider to code services rendered with correct coding initiatives. Abstracts and enters data from the medical records in order to maintain a database for statistics and reporting. Assists the Billing Department in timely billing and rebilling of patient information.

Responsibilities

• Reviews documentation in the medical record to determine ICD-10 CM and CPT-4 coding that is needed to comply with billing and reimbursement guidelines set forth by government entities.
• Verifies data in the medical record and accurately abstracts pertinent information for charge entry.
• Appropriately utilizes CPT-4 and ICD-10 current procedural coding standards in assisting the provider with proper selection and assignment of the principal procedure(s) and related diagnosis.
• Edits unbilled claim transmission reports daily and makes necessary corrections to ensure accuracy and timely billing.
• Participates in quality coding and audit reviews for each provider.
• Assists provider with coding questions for all services rendered.
• Assists other coders with coding questions to determine the most appropriate codes used for billing compliance and refers coding questions to the Operations Manager when additional research is needed.
• Contacts physicians for clarification and medical necessity.
• Reviews all encounters for accurate documentation and coding of services rendered.
• Communicates pending items and questions with office manager, CDI supervisor, and manager.
• Demonstrates ability to meet or exceed practice quality and quantity standards.
• Liaison between practice specialty and insurance company for benefit determination and claim rejections.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Professional coding experience is preferred.

Minimum Experience:

Three (3) years of extensive diagnosis and procedural coding experience required.

Licensure Requirement:

Must have and maintain a CPC coding certification through the American Academy of Professional Coders, or be registered as a Health Information Technician (RHIT) through the American Health Information Management Association.