Professional Coding Specialist III West Virginia University Hospital West Virginia University Hospital 672 reviews

Reviews all surgical

documentation to assign accurate ICD-10, CPT, HCPCS codes, and modifiers for

complex procedures performed throughout WVU Medicine. Complies with

national coding guidelines to ensure that all procedures are coded accurately

and consistently. Applies coding conventions and rules established by the

American Medical Association (AMA) and the Centers for Medicare and Medicaid

Services (CMS) when assigning procedural, diagnostic, and HCPCS codes to

ensure that they are in accordance with CCI edits, MUE edits, LCD, and

NCDs. Contacts & Collaborates with appropriate personnel for

documentation insufficiencies and to expedite resolution of accounts.

MINIMUM QUALIFICATIONS:
EDUCATION,

CERTIFICATION, AND/OR LICENSURE:
1.

High School Diploma or Equivalent.

2.

Associates

degree in Health Information Management with RHIT (Registered Health

Information Technician) or RHIA (Registered Health Information Administrator)

OR CCS (Certified Coding Specialist) or CCS-P (Certified Coding

Specialist Physician Based) or CPC (Certified Professional Coder).

EXPERIENCE:
1.

Two

years of medical coding experience required.

2.

One

year of advanced surgical coding experience required.

3.

Obtain

Specialty Medical Coding Certification within one year of hire.

PREFERRED QUALIFICATIONS:
EXPERIENCE:
1.

Four

(4) years of coding experience strongly preferred.

CORE

DUTIES AND RESPONSIBILITIES: The

statements described here are intended to describe the general nature of work

being performed by people assigned to this position. They are not intended

to be constructed as an all-inclusive list of all responsibilities and

duties. Other duties may be assigned.

1.

Accurately codes and/or audits complex surgical

procedures as part of daily workload (85%-95% of workload) including but not

limited to: Bariatric surgery, Cardiothoracic surgery, Gynecologic surgery,

Oncology surgery, Orthopaedics surgery, Thoracic surgery, Transplant surgery,

Trauma and burn surgery, and Open Vascular surgery.

2.

Reviews and accurately interprets

medical record documentation from all accounts in order to identify all

diagnosis and procedures that affect the current inpatient stay or outpatient

encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each

diagnosis and procedure that is identified.

3.

Assures that quality and timely

coding, charging and abstraction of accounts are completed daily for assigned

specialty areas.

4.

Maintains and enhances current levels of coding

knowledge through quality review, attendance and participation at clinical

in-services and coding seminars, internal meetings, study of circulating

reference materials, and inclusion of updates to coding manuals.

5.

Assures the accuracy, quality, and timely review of

data needed to obtain a clean bill.

6.

Contacts physicians or any persons

necessary to obtain information required to accurately code assignments.

Works and communicates with other offices in any manner necessary to

facilitate the billing process.

7.

Monitors on an on-going basis provider

documentation. Performs audits to assess provider coding accuracy and follows

up with provider education as needed.

8.

Provides assistance to Revenue Cycle

Operations in claim development functions to resolve problem patient

accounts.

9.

Analyzes and

resolves issues of missing charges and problem accounts by researching

information regarding department reimbursement.

10.

Interacts with physician and

non-physician providers to maximize correct coding initiatives.

11.

Maintains a level of expertise and

ever expanding knowledge in coding and sequencing guidelines to ensure that

all healthcare information is accurately assigned and appropriate.

PHYSICAL

REQUIREMENTS: The

physical demands described here are representative of those that must be met

by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities

to perform the essential functions.

1.

Must be able to sit for long periods

of time.

2.

Must have visual and hearing acuity within

the normal range.

3.

Must have manual dexterity needed to

operate computer and office equipment.

4.

Must be Able to lift, push or pull 10-20

pounds.

WORKING

ENVIRONMENT: 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.

1.

Standard office environment.

2.

Visual strain may be encountered in

viewing computer screens, spreadsheets, and other written material.

3.

May require travel.

SKILLS

AND ABILITIES:
1.

Must be able to concentrate and

maintain accuracy during constant interruptions.

2.

Must possess independent decision-making

ability.

3.

Must

possess the ability to prioritize job duties.

4.

Must

be able to handle high stress situations.

5.

Must

be able to adapt to changes in the workplace.

6.

Must

be able to organize and complete assigned tasks.

7.

Must

possess excellent written and verbal communication skills.

8.

Must

meet quality and productivity standards.

9.

Must

possess the knowledge of anatomy, physiology and medical terminology.

Date

Reviewed/Revised: August 2018

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