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Position Summary: The Certified Coding Specialist I is responsible for reviewing medical documentation provided by physicians or other health care professionals to validate or assign and sequence CPT/HCPCS, ICD-10CM, and modifiers for both clinic and hospital based professional encounters. The Coder applies coding conventions in accordance with official coding and regulatory guidelines, third-party payer policies, and departmental procedures. This role is responsible for less complex coding and is limited to hospital inpatient/outpatient and clinic E/M encounters and/or simple ancillary diagnostic procedures. Position Key Accountabilities:
Essential Functions
Resolves Epic Coding and Optum Claims Manager edits.
Responsible for reviewing encounters in the coding work queue in a timely manner and resolving all coding related edits.
Reviews medical record and accurately assigns and sequences CPT, ICD-10CM, and HCPCS codes/modifiers ensuring compliance with all applicable guidelines.
Generates basic physician queries in accordance to established procedures. Provides feedback and education as required.
Confirms that all applicable UTHealth and Coding Guidelines are being followed when resolving edits.
Performs charge entry of professional services including but not limited to non-invasive tests, anesthesia, hospital or office-based visits.
Abstracts information needed for billing of ancillary procedures or other less complex outpatient services
Resolves any applicable system errors.
Performs charge reconciliation when applicable to the department via logs, visit schedules, and other reports.
Meets the required coding quality and productivity expectations per department policy and procedure.
Maintains continuing education hours relevant to coding credential and stays up-to-date with all federal, state, coding & departmental guidelines and procedures.
Performs other duties as assigned.
Certification/Skills:
Analytical skills, ability to interpret data, and maintain spreadsheets.
Knowledge of ICD-10 CM and CPT coding conventions.
Proficiency in Microsoft Office suite, the ability to abstract data and maintain a database required
High level understanding of all federal/government regulations, coding guidance and the revenue cycle policies and procedures.
Effective verbal and written communication between internal and external customers.
Excellent time management skills required.
Self-motivated and able to work independently without close supervision.
RHIT - Registered Health Information Technician required or
CCS-Certified Coding Specialist required or
Certified Coding Specialist - Physician-based (CCS-P) required or
Certified Professional Coder (CPC) required or
Radiology Coding Certification (RCC)/Radiology Coding Certification Board (RCCB). required or
Must obtain certification within 6 months of employment, Monitoring of the certification is the department's responsibility
Minimum Education: High School Diploma or equivalent required Minimum Experience: 2 years Related coding experience required Physical Requirements: Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects. Security Sensitive: Security Sensitive: This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215 Residency Requirement:
Employees must permanently reside and work in the State of Texas.