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Job ID: 12130
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 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 CPT, HCPCS, and ICD-10
codes for professional services. Duties are performed in compliance with third
party, state and federal regulations according to standardized procedures.
Employees report to an administrative superior but independently handle
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.
● High School diploma or GED
·Successful completion of the UNC HCS Hospital OP Coder Proficiency Test.
● Must have one of the following: - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential
Professional Experience Requirements:
● Two (2) years of experience in hospital coding.
Knowledge/Skills/and Abilities Requirements:
● Strong knowledge of ICD-10-CM and HCPCS/CPT coding with excellent analytical and data mining skills. Strong knowledge of Ambulatory Payment Classification (APC) system for outpatient cases. Ability to effectively manage projects. Ability to effectively work with various levels of staff (including on-site and remote). Must possess strong communication skills, both written and verbal and have extensive attention to detail. Exhibits effective organizational skills, time management, and management of multiple priorities. Ability to interpret complex medical conditions and work with complex coding applications. Ability to have an excellent balance of being highly productive and yet produce high quality work. Ability to interpret federal and state regulations as they relate to coding and compliance.
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: HIM Hospital Coding
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: No
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.