SUMMARY STATEMENT:
Various duties including but not limited to: Ability to abstract Evaluation and Management Codes (both out and in-patient), Medicare Annual Exams, Observation visits, ICD-10 Diagnosis, Preventative visits; and other assignments as directed by supervisor.
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TYPE OF SUPERVISION RECEIVED: Reports to Supervisor for FPG/PBO WQ CPC Team, however primarily operates independently, without immediate supervision. Receives additional supervision from the Coding department leadership and Director. Daily productivity and quality will be monitored.
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Amount
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Duties and Tasks
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Rating
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Comments
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D
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M
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E
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40%
40%
varies
varies
varies
varies
varies
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A. Reviews Medical Records
Reads and analyzes physicians notes to assess them for documentation accuracy. This involves comparing physician documentation to established Evaluation and Management Guidelines to certify the appropriate category of billing and the correct level of billing within that category. Additionally, the dates of service, CPT codes, place of service and diagnostic codes billed must be corroborated in the medical record.
This assessment is required for several job functions:
-Medicare audits
-The University Professional Compliance Office annual assessment
-Internal Audits
-Physician requests for documentation review
-Clarification of inpatient billing card discrepancies
-EPIC experience
B. Work Queue Edits:
-Work assigned WQ Edits
-Verifies all information supplied
-Provides appropriate feedback for root cause/action items
C. Corresponds with physicians regarding billing issues as needed via phone, email, etc
D. Maintains Production Standards and Turn Around Time. Targets consist of a variety of E/M and procedural coding.
E. Maintains Quality Standards: Quality Reviews of 95% or better. Meets production standards while maintaining quality, accuracy, and neatness
F. Reviews new policy and procedures, standards and guidelines pertaining to coding to ensure an up-to-date knowledge and experience level. .
G. Reads publications and attends seminars to remain current on correct coding and billing procedures.
H. Provides a resource for co-workers in other areas on inpatient and outpatient charge document review, and on coding.
I. Performs special assignments including entering charges, corresponding with physicians, requesting MD reports, and anything pertaining to the completion of the patient encounter.
J. Performs other duties as assigned by Department Supervisor, Manager, or Director |
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UCLA C-I-CARE/Patient Experience Practices: MY COMMITMENT TO CARE
- Observe and practice all the Service Standards listed in the World Class Practices (which I have read and signed).
- Practice C-I-CARE when interacting with patients, their families, visitors, or internal customers.
- Connect with the patient and family members by addressing them as Mr. /Ms., or by the name that they prefer.
- Introduce yourself and your role.
- Communicate what you are going to do, how long it is going to take, and how it will impact the patient.
- Ask and anticipate patient and/or family needs, questions or concerns.
- Respond to patient and/or family questions and requests with immediacy.
- Exit courteously and/or with an explanation of what will come next (or when you will be back to check on them).
- Practice C-I-CARE phone etiquette during all phone interactions
- Always exercise courtesy whenever patients, family members, visitors and co-workers are present.
- Respect privacy and dignity of our patients, family members, visitors and co-workers.
- Maintain professionalism in the presence of patients, their families, visitors and co-workers
- Observe departmental Patient Experience plan, competencies and practices.
- Act as a role model, verbally and behaviorally demonstrating skill, enthusiasm, positive problem solving, commitment and loyalty to the profession and the organization.
- Participate in positive problem solving by providing suggestions and possible solutions to identified concerns/problems in the work place.
- Comply with Health System Workplace Conduct Policy
- Engaging in disruptive behaviors that interfere with or prevent normal work functions or compromise patient safety, including passive or active behaviors will not be tolerated as stated in the HS Workplace Conduct Policy.
- Comply with Health System Dress Code Policy and practices
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INSTITUTIONAL AND/OR PROFESSIONAL STANDARDS
- Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
- Comply with Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies standards
- Adhere to all Hospital Policies and Procedures
- Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module
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PERFORMANCE IMPROVEMENT
- Adhere to current organizational Performance Improvement priorities
- Participate in quality studies through data collection and dashboard data collection
- Make recommendations and take actions to improve structure, system or outcomes
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Ampcus, Inc
Nov 09, 2024