Job Requirements

Job Summary

Under direct supervision, assigns accurate ICD-10 diagnoses, CPT-4 procedure coding and appropriate modifiers derived from medical record documentation for complex and multi-specialties that include Emergency Room (ER), ER E/M charging, OP Trauma, Hospital and ASC Surgeries, Observation, Interventional Radiology (IR) & Cardiology and Claim Edits for facility outpatient encounters for the purpose of appropriate reimbursement, research, and compliance with federal and state regulations. This role is essential for ensuring accurate and timely coding of medical records which directly impacts reimbursement and compliance. This role requires expertise in coding guidelines and standards and proficiency in medical coding and the ability to handle moderate to complex coding scenarios.

Primary Responsibilities

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.

• Serves as a clinical coding subject matter expert and utilizes critical thinking to analyze and evaluate moderate to complex outpatient documentation for the accurate assignment of ICD10 and CPT-4 codes.
• Identifies and assigns ICD-10 diagnosis codes, CPT-4 procedure codes and appropriate modifiers to Emergency Room (ER), ER E/M charging, OP Trauma, Hospital and ASC Surgeries, Observation, Interventional Radiology (IR) & Cardiology and Claim Edits for the purpose of hospital reimbursement, research, and compliance with federal and state regulations.
• Monitors assigned work daily to facilitate the billing process within the established timeframes. Codes and abstracts records within timeframes established for each patient type.
• Maintains coding quality accuracy rate of 90%.
• Maintains productivity rate of at least 95%.
• Communicates with various departments within the hospitals regarding billing and registration issues. Refers any problems to management timely, providing clear details.
• Complies with AHIMA standards of ethical coding and coding compliance guidelines.
• Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager.
• May provide support to PB Outpatient Coding Specialists and/or act as backup, as necessary.
• Perform related duties as assigned.

Work Experience

Education & Experience - Preferred

• Associate or bachelor’s degree is preferred.

Knowledge, Skills, & Abilities

• Ability to utilize coding and EHR software (e.g., EPIC, 3M HDM) efficiently to perform coding duties.
• Knowledge and good understanding of NCCI edits, NCD & LCD requirements, and payer guidelines.
• Strong analytical, organizational, and attention to detail skills.
• Ability to prioritize workload, meet deadlines, and work effectively under pressure.
• Excellent customer service skills.
• Knowledge of general office procedures and filing systems.
• Strong problem-solving skills.
• Ability to work under minimal supervision.
• Familiar with basic medical terminology.
• Strong computer skills and typing ability.