The incumbent performs highly technical and specialized functions for the Cherokee Indian Hospital Authority. The employee reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement. The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
Complexity of Duties
Duties are highly complex, varied, require planning and coordinating several activities at one time, and demand the use of problem solving skills and analysis of circumstances to develop appropriate actions. Is subject to frequent interruptions, in person and by phone, which require varied response.
Works under the general direction of the Coding Supervisor. Has latitude for the exercise of initiatives, discretion, and independent judgment within the Cherokee Indian Hospital Authority.
Responsibility of Accuracy
Review of work and subsequent procedures would detect most significant errors of job functions. However, more serious errors could result in inefficient operations and loss of revenue.
Because information in the medical record is the basis for reimbursement as well as clinical decision-making, coding entries must be complete and accurate. The amount of reimbursement depends on the correct coding of diagnoses and procedures and appropriate DRG/APC assignment. The work has a direct effect on medical record keeping and a direct impact on the accuracy, documentation, timeliness, reliability and acceptability of information in the medical record services.
Work has considerable impact on the accreditation status of the hospital, quality of patient care, reliability of research data, compliance and the maximization of Third-Party reimbursement.
The coding function is a primary source used in health care today, and promotes provider/patient continuity, accurate data, statistic information, and the ability to optimize reimbursement.
Contacts with Others
Internal contacts occur on a regular basis with departmental personnel. External contacts include clients, families, health professionals, and general tribal population, as well as other tribal entities. Purpose for contacts is for the exchange of information requires tact, courtesy, and professional decorum. Contacts are with agencies both federal and state including: Indian Health Service, Medicaid, Medicare, and other private insurance companies. Requires the ability to organize work and deal effectively with the public and federal, state, and tribal agencies.
Has access to all departmental files, memos, financial records and medical records, which are considered confidential. Must adhere to all tribal and CIHA confidentiality policies and procedures and HIPAA Privacy and Security regulations in the performance of duties.
Close attention to detail and mental concentration for extended periods of time are required with systems problems and applications. Subject to frequent interruptions requiring varied responses. Must deal with multiple situations concurrently. Physical efforts require mobility, reaching, bending, manual dexterity, and visual acuity, and the ability to lift at least 15 pounds.
Work is performed in normal business office environment, with occasional travel required.
Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.