PRMO: , established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
General Description of the Job Class
The Medical CoderSpecialist will have frequent and daily interactions with i nternal and externalclients including but not limited to Physician and N on-physician Cardiology CATH/EP Providers. Responsibili tiesinclude diagnosis and procedural coding for the designated major sur gical specialtyareas and other procedural areas including capture of professional servicesprovided and reconciliation of all surgical or procedu ral cases performed ateach hospital where applicable. The Medical Coder Specialist focuses their workon detailed physician procedural chart abst raction as well as serves as a liaisonto documentation improvement and o ptimization of physician coding practices forcompliance and revenue purp oses. Surgical and/or procedural abstraction codingis defined as code as signment based solely on the source documentation for CPT -4 and ICD-10-CM respectively.
Duties and Responsibilities of this Level
Primarily code fromfinal procedural/ surgical ope rative reports signed by the provider. Review complexmedical records and accurately assigns codes for primary/secondary diagnosesand procedures using ICD-10-CM and/or CPT-4 coding conventions. Maintain athorough unde rstanding of anatomy and physiology, medical terminology, diseaseprocess es and procedural/surgical techniques through participation incontinuing education programs to effectively apply ICD-10-CM and CPT-4 codingguide lines to inpatient and outpatient diagnoses and procedures. Correlate in formationfrom approved supporting clinical documentation not limited to Pathology,Radiology and/or other Physician Consultations after review by the AttendingPhysician, wherever appropriate.
Provideeducation/training to physicians and other providers on coding and clinicaldocumentation. Consult with and educate/ train physicians on coding practicesand conventions in order to provide detailed coding information. Communicatewith nursing and ancillary servi ces personnel for needed documentation foraccurate coding. Provide real- time feedback to procedural/surgical providers asit pertains to proper c oding and clinical documentation of services performed.Engage in provide r/ department contact and education as the primary liaison forclarificat ionof documentation and coding for defined surgical operative casesincl uding documentation deficiencies.
Mentor and assists intraining of other coders within the depart ment. Participate in the developmentof coding policies and procedures as identified. Coordinate/mentor the work ofdesignated coding employees to ensure quality and quantity of work performedthrough regular audits. As sist with research and development of presentationmaterials for continui ng education programs for physician in their areas ofspecialization.
Interact with andprovides hi gh-level analysis of trends to Management, Revenue Managers andothers ab out Coding related issues. Researches and identifies trends inunbilled a ccounts. Contacts appropriate personnel for clinical documentationineffi ciencies. Coordinate quality reporting measures w/ providers, revenueman agers, and management. Collaborate with appeal and edit coders to expedi teresolution of accounts. Use authorized resources and systems to aid in accuratecode assignment for physician and non-physician documentation a nd surgicalabstraction. This may include but not limited to review of NC CI Edits, LCD's,NCD's, use of nThrive, and other reputable coding refere nces
Perform other relate dduties incidental to the work described herein.
Bachelor degree in medical record administration or associate degree in medical record technology or one year coding diploma or courses in Medical Terminology, Anatomy & Physiology with extensive training in coding.
Requires four years of coding experience, with at least two of those years in surgical abstraction (physician or medical group in multi- specialty surgical practices, i.e., Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.).
Degrees, Licensures, Certifications
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
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