Certified Professional Coder (CPC)

Responsible for accurate coding of all Integra Community Care Network, LLC, and Women & Infants claims generated through inpatient services, outpatient services, outpatient professional services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record. Classification systems include ICD-9-CM/ICD-10-CM, ICD-10 PCS, CPT, HCPCS as well as other specialty systems as required by diagnostic category. All work carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic for HCPCS), and CPT Assistant published by American Medical Association /ICD-10-CM Official Guidelines, CPT-4 manual, HCPCS and CMS coding guidelines. As needed, Coders may assist and be a resource for data integrity for other employees who need clarification and assistance in coding. Coders may assist in education of Integra and Women & Infants staff who provide a reimbursable service.Duties and Responsibilities:Review medical records to identify diagnoses/procedures provided by the billing provider.Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems.Demonstrates knowledge of anatomy, physiology pharmacology and pathophysiology to interpret general medical classifications for coding discharge data.Assigns Codes and codes all diagnostic and operative information from the medical record using ICD-10-CM, CPT, HCPCS coding classification systems and independently quality checks own work.Verifies and abstracts, all medical data from the record to complete a data abstract on each hospital encounter.Ensures that all data abstracted is consistent with guidelines outlined by JCAHO, and CMS, regional and local policy.Interacts with Integra Community Care Network, LLC and Women & Infants staff who provide a reimbursable service to the Integra Community Care Network, LLC members and Women & Infants patients, to clarify and accurately document patient diagnostic and procedural information.Enters patient information into the computerized inpatient and outpatient medical record databases.Ensures timely record availability by meeting established coding and abstracting productivity standards.Maintains and complies with policies and procedures for confidentiality of all patient records.Acts as an expert resource.Performs other related duties as assigned.Requirements:High school diploma or GED required.Must have at least three (3) years hospital inpatient, outpatient or surgical center coding experience within the last five years.Certification as a Certified Professional Coding Specialist (CPC).5 years of compensatory experience.Completion of classes in medical terminology, anatomy and physiology, ICD-10 and CPT coding conventions, and disease process from an accredited program.

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