Medical Records Coder Ii

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 Primary Care. 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.

• Now offering a $5,000 sign-on bonus that will pay out in 2 equal installments over 12 months - 6-month increments.

Medical Records Coder II- is responsible for processing coding-related guidelines. Duties and Responsibilities of this Level 3rd party insurance denials. The denials include bundling, medical necessity, experimental procedures, multiple frequencies, invalid or missing modifiers, global days, and ICD-9 codes. Current volumes of CPT-4 and ICD-9 must be utilized when making coding decisions. Medical records are reviewed to determine if the initial coding is accurate. Modifiers and ICD-9 codes may be added if the documentation supports the change. Appeals in the form of letters may be used in the event the initial claim was coded correctly and the coder believes the denial was in error.- Review and resolve coding-related claim denials.

Accurate interpretation of explanation of benefit coding related denial/ANSI codes- Utilize comprehensive coding tools, including CPT Assistant, NCCI edit rationale, LCD determination for Medicare, CPT-4 /IC D-9 Coding Manuals. Proficiency in navigating the manuals to identify C PT /ICD-9 descriptions and related notes to make accurate coding decisions to resolve the claim denials.- Contact insurance companies to follow up on denied claims when the denial reason is not clear.- Provide clear written instructions in the system to document proposed changes: (charge corrections, add/remove modifiers, ICD-9 or CPT codes, select appropriate appeal letters to send to the payor, and perform adjustments)- Maintain productivity and quality standards. Must be achieved on Overall Effectiveness Rating( OER) calculation scorecard- Present written recommendations to reduce or eliminate coding denials.

Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-9-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.- Maintain a thorough understanding of insurance company policies and- All other duties as assigned

Minimum Qualifications

Education

High school diploma required.

Experience

RHIA certification- no experience required RHIT certification- no experience required CCS certification- one year of coding experience required CPC or HCS-D certification- two years of coding experience required

Degrees, Licensures, Certifications

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 Certified Professional Coder (CPC) Homecare Coding Specialist-Diagnosis (HCS-D) Homecare Coding

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