E&M​/Specialty Coder

Job Summary

Under direct supervision, the E&M/Specialty Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting. Working from appropriate documentation in the medical record, assigns codes and modifiers with ICD-CM, CPT and HCPCS Level II codes. All work is performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanente organizational and institutional coding guidelines.

• Review Medical Records to identify diagnoses/procedures.
• Under supervision, codes all diagnostic and operative information from the medical record using ICD-CM, CPT and HCPCS coding classification systems.
• Verify and abstract 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.
• E&M/Specialty Coder may require specialty coding and will remain part of the responsibilities as long as business dictates.
• Corrects data as appropriate.
• Review Medical Records to resolve Ingenix and Health Connect 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-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, Medi Cal, USDOL, as well as KP Regional and Local policies.
• Work Organization and Prioritization: organize and prioritize 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: interact with clinical contracts to clarify and promote accurate documentation of patient diagnostic and procedural information.
• Enter 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 E&M/Specialty Coder position in the current Coder Work At Home agreement.
• Provides feedback to monitor service provider and line of business compliance with regulatory requirements.
• Confidentiality / Security of Systems: maintain and comply with policies and procedures for confidentiality of all patient records, demonstrate knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems.
• Other Duties: answers the telephone promptly and identifies themselves and the department.
• Acts as a resource person to other departments regarding coding questions and issues.
• Performs other duties as assigned.

Grade 594