Clinical Coding Technician

GENERAL DESCRIPTION: Responsible for the coding and analysis of clinical information contained in medical claims and admission and outpatient medical records, to assign diagnosis and/or procedure codes following the rules outlined in the ICD-10-CM classification system. Serves as liaison between the Risk Assessment Unit and the provider, Hospital MIS department, Outpatient Clinics, Billing staff, and/or medical office representatives, to guarantee correct code assignment through validation of codes on medical claims, identify educational needs, and provide necessary guidance related to correct medical coding practices. Keeps up to date with all coding guidelines established by the different accrediting agencies, such as Medicare, AHIMA, AMA, and so on. Complies at all times with coding ethics standards established by AHIMA. ESSENTIAL FUNCTIONS: •Codes the diagnoses documented in the CHRA (Comprehensive Health Risk Assessment). Registers them in the electronic app. •Appropriately codes inpatient and/or outpatient medical services through review of medical record documentation and/or medical claims, assigning ICD-10, CPT, and modifier codes based on documentation, billing requirements, and so on. •Responds to referrals and diagnostic coding inquiries. •Evaluates data rejected by Medicare for diagnoses submitted in RAPS (Risk Adjustment Processing System) and EDS (Encounter Data System). Executes the operational processes established for correction and retransmission to CMS •Establishes written and telephonic communication with providers, authorized representatives, and/or billing personnel to offer guidance and/or request correction of medical diagnoses due to incorrect coding, and inadequate or ambiguous medical documentation. •Guides the personnel in charge of medical record review and validation of diagnoses related to proper medical coding practices. •Identifies areas of opportunity arising from incorrect coding to reduce rejected data in the system and avoid situations that represent a risk to compliance with coding guidelines. Refers them to the Supervisor and submits reports as required. •Audits diagnoses validated by the Clinical Review Specialist in the review of medical records. •Responsible for keeping up to date with coding policies and best practices, as well as annual changes in codes, without being directly required to do so. ADDITIONAL FUNCTIONS: • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS: Education and Experience: Associate’s degree in Health Information Management Technology from a University or educational entity recognized by AHIMA. At least one (1) year of experience in the extraction of diagnoses and procedures and interpretation of medical records for coding purposes, for both inpatient and outpatient medical services, working in hospitals, medical offices, insurance companies, and so on. OR Education and Experience: Sixty (60) college credits equivalent to two (2) years of study or an Associate degree. At least three (3) years of experience in the extraction of diagnoses and procedures and interpretation of medical records for coding purposes, for both inpatient and outpatient medical services, working in hospitals, medical offices, insurance companies, and so on. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: A valid Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician (CCS-P) are preferred. Other: Extensive knowledge of medical coding systems using the following classification systems: ICD-10-CM, CPT 4, HCPCS, ICD-O, as well as the use of essential modifiers. Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)