Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD-10, CPT, and HCPCS, modifier and/or other codes according to coding guidelines. Communicates effectively with providers and/or all appropriate staff regarding missing information such as CPT, ICD-10, and documentation issues, to ensure proper coding and reimbursement. Works with the Associate Director to review denial and reimbursement reports for accuracy, as well as conducting audits to ensure documentation, code capture, and billing are accurate and precise. Performs pre and post visit chart audits to ensure proper code assignment.
PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
Performs pre-visit chart audits, and post encounter review to ensure coding accuracy:
Maintains a current and strong understanding of coding rules and CMS guidelines in the outpatient settings:
Reporting:
EDUCATION:
EXPERIENCE:
WORKING CONDITIONS/PHYSICAL DEMANDS:
All your information will be kept confidential according to EEO guidelines.
AMERICANS WITH DISABILITIES STATEMENT:
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.
COVID-19 POLICY:
Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.