Professional Services Coder II - Grade 594

The Professional Services Coder II under direct supervision is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from the appropriate documentation in the medical record, assigns codes and modifiers with ICD-9-CM, CPT and HCPCS Level II codes. All work is performed in accordance with the rules, regulations and coding conventions of ICD-9-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-9-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanente's organizational and institutional coding guidelines. A Professional Services Coder II assigns codes for professional services rendered in the following settings: Hospital, Emergency Department (ED), Hospital Observation (HOPS), Hospital Ambulatory (HAS), Hospital Outpatient (HOV) and Medical Office.

Essential Functions:

• Review Medical Records to identify diagnoses/procedures.

• Under supervision, codes all diagnostic and operative information from the medical record using ICD-9-CM, CPT and HCPCS coding classification systems.

• Verifies and abstracts all medical data from the record to assign appropriate codes for the following settings: Inpatient Hospital (IP), Hospital Emergency (ED), Hospital Observation (HOPS), Hospital Ambulatory (HAS), Hospital Outpatient (HOV) and Medical Office.

• Corrects data as appropriate.

• Review Medical Records to resolve Ingenix and HealthConnect Coding Edits.

• Under supervision, identify and resolve coding related edits by reviewing the medical record and ensuring that all data and codes are consistent with ICD-9-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, MediCal, USDOL, as well as KP Regional and Local policies.

• Correct data as appropriate.

• Work Organization and Prioritization:Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved, in a timeframe that will assure compliance with regulatory, billing and SOX requirements.

• Completeness of Medical Record Data.

• Under general supervision, interacts with clinical contacts to clarify and promote accurate documentation of patient diagnostic and procedural information.

• Enters patient information into the computerized medical record and billing systems, ensuring the accuracy and integrity of the medical record data abstracted or encounter data corrected, prior to submitting the data.

• Ensures timely data completion by meeting coding/abstracting productivity/quality standards established for the Professional Service Coder II.

• Provides feedback to monitor service provider and line of business compliance with regulatory requirements.

• Confidentiality/Security of Systems: Maintains and complies with policies and procedures for confidentiality of all patient records.

• Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained.

• Consistently supports the precepts of Corporate Compliance and the Principles of Responsibility by maintaining confidentiality, protecting the assets of the organization, acting with integrity, reporting observed fraud and abuse and complying with applicable state, federal and local laws and program policies and procedures.

• Answers the telephone promptly and identifies themselves and the department.

• Acts as a resource person to other departments regarding coding questions and issues.

• Other duties as assigned.

Basic Qualifications:

Experience

• Minimum of two (2) years, within the last three (3) years, certified professional coding experience.

Education

• Completion of classes in medical terminology, anatomy and physiology, ICD-9-CM and CPT coding conventions, and disease process from an accredited program is required.

• Must have high school diploma or GED.

License, Certification, Registration

• Any one of the following certification: Certified Professional Coder (CPC); Certified Coding Specialist for Professional Services (CCS-P); Registered Health Information Technician (RHIT).

Additional Requirements:

• Achieve a minimum score of 80% on the Professional Services Coder II test.

• Basic knowledge of and use of computer and computer keyboard (able to pass the PC skills assessment).

• Must be able to meet production and quality standards established for the position.

• Demonstrated knowledge of anatomy and physiology, medical terminology, disease processes.

• Demonstrated ability to understand the clinical contents of a health record.

• Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing.

• Basic knowledge of reimbursement methodologies and conventions.

• Knowledge of rules and guidelines for current coding classifications.

• Practical knowledge of hospital and/or physician clinic based revenue cycle.

• Practical knowledge of professional services coding and billing in a multi-specialty environment.

• Practical knowledge of government and other payer coding, billing and collection rules and regulations.

• Must maintain current coding credential and perform associated Continuing Education Units.

Preferred Qualifications:

• N/A.

Skills Testing: PC Skills Assessment & Professional Services Coder II Test (80%)