PRMO: , established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
General Description of the Job Class:
The HIM Coder Tech II utilizes experience, education, coding guidelines and Duke coding policies and procedures to perform all daily duties.
Performs evaluation and review of medical record documentation to accurately assign codes for the primary/secondary diagnoses and procedures using ICD-10-CM, ICD-10-PCS, CPT-4 and HCPCS Level II.
Sequence the diagnoses and procedures using coding guidelines and ensures DRG or APC assignment is accurate.
HIM Coder Tech II focuses their work on capturing data with consideration for regulations and requirements to support medical necessity and reimbursement.
Duties and Responsibilities of this Level:
Review medical record documentation and accurately assign codes for the primary/secondary diagnoses and procedures using ICD-10-CM, ICD-10-PCS, CPT-4 and HCPCS Level II. Sequence diagnoses and procedures using coding guidelines.
80% of time spent:
Maintain competency in ICD-10-CM, ICD-10-PCS, CPT-4 and HCPCS Level II and knowledge of reimbursement reporting requirements.
Maintain a thorough understanding of anatomy and physiology, medical terminology, pharmacology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM coding guidelines for assignment of outpatient diagnoses and CPT-4 and HCPCS Level II for procedures.
Knowledge coding and charging requirements to ensure accurate code submission along with management of edits and denials.
Knowledge of UHDDS definitions and data requirements to support accurate coding and data collection.
Knowledge of NCD/LCD edits to support compliance with medical necessity requirements.
Apply knowledge of all coding reference materials and education to problem solve unique or new cases resulting in the assignment of appropriate diagnosis and procedure codes.
5% of time spent
Use logic and reasoning to demonstrate critical thinking in the assignment of diagnosis and procedure codes with consideration for reimbursement, quality and other data capture requirements.
10% of time spent
Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. 5% of time spent.
Maintain compliance with quality and quantity standards as outlined in DUHS HIM Coding Policies.
Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level:
Associates degree in health information management or High School diploma.
2 or more years of coding experience
Degrees, Licensure, and/or Certification:
Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS)
Must hold one of the following active/current certifications:
Registered Health Information Administrator (RHIA) Hospital Coding
Registered Health Information Technician (RHIT) Hospital Coding
Certified Coding Specialist (CCS) Hospital Coding
Knowledge, Skills, and Abilities:
Understand and apply appropriate Centers for Medicare and Medicaid Services (CMS) coding guidelines
Knowledge of denial management processes
Basic ICD-10-CM and PCS coding conventions
Advanced ICD-10-CM & CPT-4 coding conventions
Anatomy and Physiology
Extensive DRG/APC reimbursement knowledge
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke is an Affirmative Action/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, sexual orientation, or veteran status.
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob 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.
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