Clinical Coding Specialist - ProFee

MISSION STATEMENT

The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research, and prevention and through education for undergraduate and graduate students, trainees, professionals, employees, and the public.

SUMMARY

 Analyzes medical records and abstracts clinical data by assigning codes from patient records in accordance to coding classification systems. Reviews patient encounters for accurate code assignment of all relevant diagnoses and procedures. Enters appropriate codes into the hospital's mainframe computer for the transfer of data to billing files for reimbursement. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes. Serves as a resource for other department users related to the abstracted coded data.

JOB-SPECIFIC COMPETENCIES/RESPONSIBILITIES:

PEOPLE/SERVICE – (34%)

·       Queries physicians and/or departments when code assignments are not straightforward, or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.

·       Must be flexible and adapt to changing work assignments.

·       Meet or exceed department production and accuracy standards.

·       Response promptly to internal and external reviews for clarification, Business office requests, or reviews for accuracy

·       Identify workflow issues and promptly inform management

CODING QUALITY/PROTECTED HEALTH INFORMATION – (40%)

·       Possess a thorough knowledge and understanding of institutional coding policies and procedures; maintains knowledge of ICD-10-CM, HCPCS, and CPT-4 coding guidelines according to CMS, AMA, AHA, and other official sources.

·       Analyzes medical records and abstract clinical data by assigning codes (ICD10, CPT, HCPCS) from patient records in accordance with coding classification systems.

·       Reviews patient encounters for accurate code assignment of all relevant diagnoses and procedures.

·       Exports appropriate codes from CodeRyte/CodeAssist and/or Epic charge systems.

·       Assign appropriate modifiers and apply guidelines as indicated through the Limited Coverage Diagnosis (LCD), as well as the National Correct Coding Initiative (CCI).

·       Resolves coding edits in Epic by performing a second review of medical record documentation and code assignments.

·       Must exercise good judgment in making decisions in regard to coding and/or auditing outcomes.

DEVELOPMENT/INNOVATION – (26%)

·       Advance professional growth and development of skills through continuing education, departmental coding rounds, and reviewing pertinent literature and educational forums.

·       Participates and provides ongoing feedback, when necessary, on documentation challenges, potential coding compliance concerns, and opportunities for coding clinic updates.

·       Participates in ongoing team and departmental staff meetings.

***Other duties assigned; descriptions above are not all-inclusive. The coding specialist will perform coding-related functions within the scope of responsibilities when requested.