MEDICAL CODER SPECIALIST

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

Occ Summary

The Medical Coder Specialist will have frequent and daily interactions with internal and external clients, including but not limited to physicians and Non-physician Surgical Providers. Responsibilities include primary diagnosis and procedural coding for the designated major surgical specialty areas and other major procedural areas, including capture of applicable Physician Quality Reporting System (PQRS) and reconciliation of all surgical cases performed at each hospital where applicable. The Medical Coder Specialist focuses their work on the detailed physician surgical chart abstraction, as well as being an immediate liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes for the providers in these areas. Surgical abstraction coding is defined as the identification of codes based solely on the source documentation for CPT and ICD-10-CM, respectively.

Work Performed

Primarily code from final surgical / procedural operative reports signed by the provider. Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary / secondary diagnoses and procedures using ICD-10-CM and / or CPT coding conventions. Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures. Correlate information from "approved" supporting clinical documentation, not limited to Pathology, Radiology, and / or other Physician Consultations, after review by the Attending Physician, wherever appropriate. Provide education / training to physicians and other providers on coding and clinical documentation. Consult with and educate / train physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to surgical / procedural providers as it pertains to proper coding and clinical documentation of services performed. Engage in provider / department contact and education as the primary liaison for clarification of documentation and coding for defined surgical operative cases, including documentation deficiencies. Mentor and assists in the training of other coders within the department.

Participate in the development of coding policies and procedures as identified. Coordinate / mentor the work of designated coding employees to ensure quality and quantity of work performed through regular audits. Assist with research and development of presentation materials for continuing education programs for physician in their areas of specialization. Interact with and provide high-level analysis of trends to Management, Revenue Managers, and others about coding-related issues. Researches and identifies trends in unbilled accounts. Contact appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures with / providers and revenue managers / management (PQRS). Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized electronic media / systems for Physician and Non-physician Clinician documentation, Coding Abstraction for each Surgical Procedure, Review of CCI Edits, LCD, and NCD coverage. Perform other related duties incidental to the work described herein.

Knowledge, Skills, and Abilities

Extensive knowledge of coding surgical procedures, applicable modifiers in a multi-specialty setting. Understands and applies appropriate Center Medicare Services guidelines to coding Advanced ICD-10-CM & CPT-4 coding conventions, Anatomy and Physiology, Medical Terminology. Extensive DRG / APC reimbursement knowledge, Coding software familiarity, Effective written and verbal communication skills, Data entry / CRT

Level Characteristics

Code and abstract from Surgical Operative Notes while providing the primary communication with / specialty surgical providers in the health system.

Minimum Qualifications

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation, or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions :

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and / or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Education

Bachelor's degree in medical record administration or associate degree in medical record technology, or a year coding diploma or courses in Medical Terminology, Anatomy & Physiology with extensive training in coding.

Experience

Requires four years of coding experience, with at least two of those years in surgical abstraction (physician or medical group in multi-specialty surgical practices, i.e., Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.).

Degrees, Licensures, Certifications

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS), or Certified Professional Coder (CPC)

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions :

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and / or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.