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Job ID: 6377
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Performs technical and administrative work reviewing, abstracting and assigning accepted medical codes for outpatient (Hospital Billing – Health Information Management) diagnoses and procedures for ambulatory surgery and observation services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures.
1. Assigns International Classification of Diseases (ICD-10-CM) diagnosis codes in an accurate and productive manner.
2. Assigns all codes to chronic conditions documented that may impact Hierarchal Condition Categories (HCCs) or expected mortality.
3. Assigns Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in an accurate and productive manner.
4. Groups codes and completed product into payment groups. Analyzes information for optimal and proper reimbursement.
5. Reviews National Coverage Determination (NCD), Local Coverage Determination (LCD), and Correct Coding Initiative (CCI) edits and any other coding edits and applies changes to code assignments appropriately, and/or adds modifiers appropriately.
6. Recognizes and has knowledge of Medical Necessity requirements and resolves edits during code assignments.
7. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures.
8. Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
9. Reviews, analyzes and abstracts physician/other documentation for diagnoses and other services provided.
10. Obtains missing information and/or clarifies existing information.
11. Accepts feedback from Auditor as needed to avoid future errors.
12. Accepts feedback from PWC Smart reviews and makes edits as needed to avoid future errors.
13. Reviews and processes PWC SMART edits.
14. Researches appropriate databases for validation of information.
15. Utilizes a variety of software (e.g. Epic, Optum CAC, MS Office, etc.) to compile and validate medical information.
Knowledge/Skills/and Abilities Requirements:
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.