Job Description

Staff Position Description

Position Title: Professional Services Certified Coding Reviewer Position Code: Coder-8125

Department: Health Information Management Safety Sensitive: YES

Reports to: HIM Director/Manager Exempt Status: NO

Position Purpose:

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

Key Responsibilities

Ensures data quality in compliance with State, Federal and regulatory requirements.

 Evaluates medical record documentation and charge reports to ensure completeness, accuracy and

compliance with the Correct Coding Initiative Edits.

 Codes all professional charges to ensure accurate and timely billing

 Perform coding reviews and/or surgical coding for practices and providers.

 Evaluates and report audit findings or reviews and reports on results to physicians and/or operations

directors.

 Provides technical guidance, training, and on-going coding education when instructed, to physicians

and their office staff and other ancillary departments on both general and specific coding issues to

include documentation and guidance in quality coding for proper collection of health data.

 Evaluate insurance requests and claim denials to assist the Business Office with the revenue cycle.

 Manage work activities, work assignments and schedules to ensure accurate and timely submission of

information.

 Provides reports as requested on data collected, abstracted and coded.

 Review bulletins, newsletters and periodicals and attends workshops to stay abreast of current issues,

trends and changes in the laws and regulations governing medical record coding and documentation.

 Demonstrates dependability, teamwork, and maintains patient confidentiality.

 Develops and maintains excellent relationships with providers, provider’s staff, operational directors,

and business office staff.

 Works well with individual practices, the Business Office, and Operation Directors.

 Strives to be a productive member of this institution, attends departmental meetings as required,

maintains certification, and obtains continued education units (CEU).

 Completes all other duties, projects, and assignments as directed/requested.

Qualifications

 Advanced knowledge of ICD-10-CM, CPT, HCPCS, Medical Terminology and medically approved

abbreviations required.

 Thorough understanding of CMS coding and billing guidelines required.

 Excellent written and verbal communication skills and critical thinking skills.

 Ability to work independently and make independent decisions based on specialized knowledge.

 Computer literacy and familiarity with the operation of basic office equipment, required.

Education High school diploma or equivalent

Certification/Licensure Maintains current Certified Coding Specialist (CCS) issued by the American

Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) issued by the

American Academy of Professional Coders (AAPC), or currently enrolled in AHIMA or AAPC and actively

working towards obtaining Coding Specialist (CCS) issued by the American Health Information Management

Association (AHIMA) or Certified Professional Coder (CPC) issued by the American Academy of

Professional Coders (AAPC). Certification required within 12 months of hire or placement in this position.

Preferences

Experience Experience in a medical billing/coding office.

Special Position Requirements [Optional section: any travel, security, risk, hazard or related special conditions which apply to the position]

· Travel to off-site locations as required.

Exposure Categories: Category II: Expected duties have possible, but not routine, potential for exposure to blood, body fluids or tissues

Work Requirements [Optional section: work requirements for physical or other important issues which relate to the job]

· Ability to stand and walk in the performance of job responsibilities.

· Ability to work at a computer for extended periods.

· Some bending and lifting may be required.

Date Staff Position Description Created / Revised: 03/21/2019