Medical Coder I/II/III- Echo Cliffs Health Center

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act.  Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.
Overview

PRIMARY FUNCTION:

The incumbent performs highly technical and specialized functions by reviewing, analyzing, and coding diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments.  The primary function of this position is to perform medical coding for continuing patient care and reimbursement.  The coding function is a primary source for data and information used in health care, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function(s) ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.  The potential for working remotely does exist as long as the factors in the remote workers policies can be met.

Qualifications

NECESSARY QUALIFICATIONS:

Education:

High School Diploma or GED

 

Experience:

       Certified Medical Coder I

• Must have at least three (3) months to a year of experience with medical coding

Certified Medical Coder II

• Must have two (2) years of medial coding experience

Certified Medical Coder III

• Must have five (5) years of medical coding experience

 

Certifications:

Must have and maintain current coder certification with AHIMA/AAPC

 

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.  All employment references must address and indicate success in each one of the following areas:

• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Positive working relationships with others
• Maintains a positive professional attitude and demonstrates good interpersonal communication skills
• Advance knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record
• Knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS)
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

Responsibilities

ESSENTIAL FUNCTIONS:

Certified Medical Coder I

• Relies on instruction and pre-established guidelines to perform the functions of the job
• Work under immediate supervision or team lead

Certified Medical Coder II

• Relies on limited experience and judgment to plan and accomplish goals and performs a variety of tasks
• Works under general supervision with a certain degree of creativity and latitude

Certified Medical Coder III

• Relies on extensive experience and judgment to plan and accomplish goals
• Performs a variety of tasks and may lead and direct the work of others
• A wide degree of creativity and latitude and works independently; provides detailed reports to Supervisor/Manager

1. 1. Assigns and sequences medical codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the physician are valid and complete.  Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
   2. Abstracts all necessary information and assigns medical codes, which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
   3. Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Correlates generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct medical code.  Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct medical code.
   4. Coder’s accuracy/quality of coding must be at 95% per monthly, quarterly and yearly audit results (as determined by the facility compliance officer). Coding productivity must meet best practices per patient types.
   5. Quantitative analysis – Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
   6. Qualitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered.  Reviews the records for compliance with established third party reimbursement agencies and special screening criteria.
   7. Enroll in continuing education courses to maintain certification.
   8. Performs other duties assigned by the Director or Lead Coder.
   9. Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering face piece respirator or higher, if available), and eye or face shield.
   10. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
   11. Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction.