Medical Records Coder II-Commitment Bonus

Work Arrangement:

Requisition Number: 253905

Regular or Temporary: Regular

Location:

Durham, NC, US, 27710

Personnel Area: PRMO

Date: Jan 27, 2025

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

Commitment Bonus: $10,000 (4 equal installments over 24 months in 6-month increments)

General Description of the Job Class

Coordinate/review the work of vendor outsourcing partners and assist with the training and continuing education programs. Code medical records utilizing ICD-10CM, CPT-4, and HCPCS Level II coding conventions. Review the medical record to ensure specificity of diagnoses, procedures, and appropriate rate/optimal reimbursement professional charges. Abstract information from medical records following established methods and procedures.

Duties and Responsibilities of this Level

· Ensure quality and quantity of work performed through regular audits and QC for vendor services specifically in the area of PB Charge Review, HB Claim Edits, PB/HB coding-related De nials, Rejections, and the Quality of HB Appeals done by Vendor Coders.

· Monitor and track outsourcing vendor performance as it pertains to QC and Productivity

· Review and research the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10 CM and/or CPT, HCPCS coding conventions, and payer-specific coding guidelines.

· Develop and assist training, presentations, and educational tools for any relevant topic as it relates to continuing education programs on areas of specialization, coding, operational workflow, and quality control including cross-training to other QC areas

· Collaborates with other departments and partners (e.g. Revenue Integrity, QA Team, Compliance Specialist, Internal Controls, Billing and Collections, and Revenue Managers) to ensure coding feedback to outsourcing vendors and teams is provided.

· Abstr act and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.

· Consult with and provide feedback to physicians or departments. Communicate with clinical, ancillary staff, and revenue managers for needed documentation to ensure accurate coding.

· Develop and 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-10 CM and CPT-4 coding guidelines to inpatient/outpatient diagnoses and procedures.

Develop and maintain a thorough understanding of medical record practices, standards, regulations, Health Care/Finance Administration (HCFA) and Uniform Billing(UB-04), CMS, and other payer policies and any health care relevant changes.

· Develop and maintain a thorough understanding of payer-specific guidelines as it pertains to edit review and denial management.

· Ensure active participation in any team event and departmental activities in the PRMO and DUHS

· Ensure compliance with PRMO and DUHS policies and code of conduct

· Assist with special projects as required

Medical Records Coder II – Vendor Support – Phase I/II

This is a progressive coder/auditor position, with opportunities for development and growth, accountable for key strategic vendor education, and ensures coding accuracy for the vendor services. The ideal candidate has experience and knowledge in coding/billing, denials, and payer guidelines as well as well-developed analytical skills in this area. The position is a forward-facing role that will have regular access/communication with our coding vendor partners. Coding certification is required.

Quality Control – (40%)
- Review of vendor work to identify erroneous coding patterns and errors including reporting and data record keeping
- Providing feedback and education to vendor services to address issues found
- Monitoring and tracking of QC result
- Provide process analysis and s support for the department as an expert for Outsourcing partner QC team and supervisors

o Performing actual coding functions inc including but not limited to edits, denials, and rejections.

o Performing necessary research and investigation to resolve coding-related issues and enhancement the business process associated with job functions and responsibilities

o Maintaining coding skills by continuing education and keeping abreast of regulatory healthcare-related changes and payer’s rule updates.

o Plan activities aimed at improving the Coding Vendor’s quality performance in operations

and Design and implement strategies for enhancing the vendor’s work quality and increasing productivity.

o Evaluate the effectiveness of improvement strategy through sustained tracking and monitoring of vendor’s related WQ.

o Reporting o f vendor specific trends and issues to upper management

Coding (40%)
Vendor Education (20%)

Required Qualifications at this Level

Education:

High school graduate, bachelor is preferred

Experience:

Minimum of 2 years work experience in Coding and/or Coding Auditing experience. Epic experience is preferred.

< strong>Degrees, Licensure, and/or Certification:

CPC, CPC-P, CCS, CCS-P, CPMA, COC, RHIA, RHIT

Knowledge, Skills, and Abilities:

Effective written and verbal communication skills

Ability to communicate with customers/staff with diverse educational backgrounds

Ability to provide feedback and education in a group setting or over Zoom

Analysis of data and processes for opportunities for improvement

Attention to detail and accuracy

Computer literacy

Distinguishing Characteristics of this Level

Be able to teach coding effectively to a diverse audience.

The intent of this job description is to provide a presentative level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.

Minimum Qualifications

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunities without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provisions for requests for reasonable accommodation wi be provided by each hiring department.

Education

High school diploma required.

Experience

RHIA certification- no experience requiredRHIT certification- no experience required certification- one year of coding experience required dCPC or HCS-D certification- two years of coding experience required

Degrees, Licensures, Certifications

Must hold one of the owing active/current certifications: Registered Health Information Administrator (RHIA) Hospital CodingRegistered Health Information Technician ( RHIT) Hospital CodingCertified Coding Specialist (CCS) Hospital care certified Professional Coder (CPC) care coding Specialist-Diagnosis (HC S-D) Homecare Coding.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.