MEDICAL CODER SPECIALIST

PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
Occ Summary

The medical coder specialist (GI) 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 physic-ian 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-9-CM, respectively.

Work Performed

Primarily code from final surgical or procedural operative reports signed by the provider. Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary and secondary diagnoses and procedures using ICD-9-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-9-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 or 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 the 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 or mentor the work of designated coding employees to ensure the quality and quantity of work performed through regular audits. Assist with the research and development of presentation materials for continuing education programs for physicians in their area of specialization. Interact with and provide high-level analysis of trends to management, revenue managers, and others about coding-related lawsuits. Researches and identifies trends in unbilled accounts. Contact appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures with providers and revenue managers (PQRS). Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized electronic media and systems for physician and on-physician clinician documentation, coding abstraction for each surgical procedure, review of CCI edits, LCD, and NCD coverage. Perform other related duties incidental to the work described herein.

Knowledge, Skills, and Abilities

Extensive knowledge of coding surgical procedures and applicable modifiers in a multi-specialty setting Understands and applies appropriate Center Medicare Services guidelines to code Advanced ICD-9-CM and CPT-4 coding conventions. Anatomy and Physiology Medical Terminology Extensive DRG/APC reimbursement knowledge and coding software familiarity Effective written and verbal communication skills Data entry/CRT

Level Characteristics

Code and abstract from Surgical Operati ve Notes while providing primary communication with specialty surgical providers in the health system.

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)

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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.