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Critical Access Hospital Coding Specialist


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Title: Critical Access Hospital Coding Specialist

Department: Revenue Cycle Resources

Reports To: Coding Manager

Supervises: None

Status: Casual/PRN (Remote)


Position Summary:

The Critical Access Hospital Coding Specialist will be responsible for critical access hospital coding in one or more of the following coding specialties: professional, outpatient, ER, surgery, observation, and inpatient CAH (no DRG assignment). They will ensure the timely and accurate coding of medical claims. Furthermore, they will ensure maximum reimbursement for services provided by utilizing sound knowledge of coding rules and regulations, best practice workflows, and the use of multiple software systems.


Qualifications:

Education and/or Experience:

• High School Diploma is required, Associates is preferred.


Licenses/Certifications Required:

  • Certified Coding Specialist (CCS), Certified Outpatient Coder preferred

  • Five+ years medical coding experience is required.

  • Knowledge of medical terminology is required.

  • Proficient with Microsoft Office


General Requirements/Job Duties:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:

Charge Entry:

  • Receive and review charge entry data.
  • Identify and investigate incomplete or missing charges.

 

Coding:

  • Abstracts clinical information; translates medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems.
  • Sequences codes according to established guidelines.
  • Thoroughly analyzes and interprets medical information, medical diagnoses, coding/classification systems, to ensure accuracy for prospective payment system reimbursement.
  • Conducts training for physicians/staff on coding and or documentation practices.
  • Maintains working knowledge of reimbursement systems and how coding integrates and effects reimbursement.
  • Serves as a resource/mentor/trainer for entry level coders.
  • Capable to assist with reimbursement analysis.
  • Conducts coding and/or billing audits as required.

 

Other:

  • Maintains current knowledge of coding rules and regulations as designated by the AMA, Centers of Medicare and Medicaid Services (CMS) and other payers.
  • Maintains proficient knowledge of EHR, as well as any other systems, required for performing required job duties.
  • May perform other billing functions including claim submission, unpaid claims follow-up, denial resolution.
  • Communicates issues to management, including payer, system, or escalated account issues. Identifies medical necessity denial trends and provide suggestions for resolution.
  • Participates in department meetings, in-service programs, and continuing education programs.
  • Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient information, maintaining compliance with policies and procedures.
  • Performs other duties as assigned.


Security/Access:

• Will have access to primary work location 24 hours a day.
• Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.


Equipment Used:

• General office equipment to include: fax, copier, computer, printer, etc…
• Telephone


Patient Age Groups Served:

None.


Essential Work Environment & Physical Requirements:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical ActivityNot ApplicableOccasionally (0-35% of day)Frequently (36-66% of day)Continuous (67-100% of day)
Sitting  X
Standing X 
Walking X 
ClimbingX   
Driving X  
Lifting (Floor to waist level) 40 lbs.10 lbs. 
Lifting (waist level and above) 40 lbs.10 lbs. 
Lifting (Shoulder level and above) 40 lbs.10 lbs. 
Carrying Objects  X 
Push/Pull 40 lbs. 10 lbs.
Twisting X  
Bending X  
Reaching forward X  
Reaching Overhead X  
Squat/kneel/ crawl X  
Wrist Position Deviation   X
Pinching/Fine Motor activities X  
Keyboard use/ repetitive motion   X
TasteX   
Talk   X
Smell X  
Hear   X
Sensory RequirementsNot ApplicableAccurate 20/40Very Accurate 
Near Vision X  
Far Vision X  
 Not ApplicableYesNo 
Color Discrimination X  
 Not ApplicableAccurateMinimalModerate
Depth Perception X  
Environment Requirements (Occupational Exposure Risk Potential)Not AnticipatedReasonably Anticipated
Bloodborne PathogensX 
ChemicalX 
Airborne Communicable DiseaseX 
Extreme TemperaturesX 
RadiationX 
Uneven Surfaces or ElevationsX 
Extreme Noise LevelsX 
Dust/Particulate MatterX 
Other (Listed)  
Shift Requirements8 hrs/day10 hrs/day12 hrs/dayOther (varied)
Usual workday hoursX   
 Not ApplicableYesNo 
Reliable, punctual attendance for assigned shifts X  
Available to work overtime X  
Telecommuting available? Yes