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Responsible for accurately identifying and sequencing all diagnoses/procedures/ HCPCS items (whichever is applicable per project) to assure appropriate reimbursement and maintenance of an accurate database, in a timely manner. Applies current coding guidelines, implement regulatory changes, obtain additional and/or clarification of documentation from physicians and clinical staff per approved protocol to assure documentation supports diagnoses/procedures/ HCPCS items coded. The employee must be able to function with a high degree of independence and considerable discretion
Able to assign and sequence ICD-10-CM/PCS/CPT/HCPCS codes to diagnoses and procedures for documented information. Assures the final diagnoses and/or operative procedures as stated by the physician and or acceptable health care provider are valid and complete. Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
Determines the final diagnoses and/or procedures stated by the physician or other health care providers are valid and complete.
Quantitative analysis – Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
Qualitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party reimbursement agencies and special screening criteria.
Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code (If applicable).
Knowledge on Excel, word, Outlook.
Flexible as may be tasked for other new or additional projects.
Excellent verbal and written communication skills and ability to relate well under any certain environment.
Commits to achieving Performance Metrics under specified timeframe, and maintaining the same.
Demonstrate ability to self-motivate, set goals.
Adheres to attendance and shift protocols.
Applicants must possess at least Bachelor’s/College Degree in any Health Science course, preferably BS Nursing
Applicants must be at least a Certified Professional Coder
Willing to work in Ortigas and on day shift
Maintains confidentiality of Patient Health Information (PHI).
Compliance with the company’s security principles, policies, standards, procedures and guidelines its laws and regulations.
Actively participates in coding meetings and educational reviews or sessions within Omega.