MEDICAL CODER

General Purpose of Job:

Extract and analyze clinical information and translate into the most accurate ICD-10-CM, CPT, and other specialized codes and modifiers to ensure appropriate reimbursement and accurate and reliable data for research, statistics, financial planning, compliance, and marketing. Make corrections to coding edits and charges. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine - Sparrow policies and procedures and maintains required quality and productivity standards.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Extracts, reviews, and analyzes clinical information, identifies and abstracts all pertinent information and translates data into appropriate ICD-10-CM, CPT, and other specialized codes and modifiers for appropriate reimbursement, research, statistics, financial planning, compliance and marketing to ensure completeness, accuracy and compliance with established guidelines of all governmental regulatory agencies and third party payers.
• Works under fast-paced circumstances to meet turnaround time requirements. Meets or exceeds departmental/unit performance standards.
• Exercises independent judgment in determining case complexity by utilizing clinical knowledge in order to understand the etiology, pathology, signs, symptoms, diagnostic studies, treatment modalities and prognosis of diseases and procedures to be coded.
• Researches complex diagnoses and/or procedures as needed to enhance coding knowledge to consistently apply the correct codes.
• Identifies issues and makes recommendations for resolution and improvement.
• Escalates patient safety, customer service, quality, and compliance concerns to leadership. Communicates with unit leadership regarding policy and procedures.
• Interacts closely with providers and queries the medical staff appropriately and professionally to obtain accurate documentation necessary to ensure coding compliance and accuracy.
• Expands job-related knowledge and skills by attending and participating in in-services and staff meetings.
• Maintains currency with work processes, tools, and clinical and administrative applications necessary to perform job functions, including, but not limited to, keeping abreast of coding guidelines and quarterly Coding Clinic and monthly CPT Assistant.
• Attends required system, hospital and departmental meetings and educational sessions as established by leadership, and completes required annual learning programs, to ensure continued education and growth.
• Responsible for ensuring accuracy and maintaining established quality and productivity standards, as well as key performance indicators.
• Demonstrates an understanding of University of Michigan Health - Sparrow departmental and unit policies and procedures and seeks clarification as needed.
• Complies with regulatory, legal, and accreditation requirements and seeks clarification as needed.
• Assures adherence with safety programs.