Lourdes Health System

Medical Billing and Coding

• Codes and abstracts hospital medical records for diagnostic and procedural coding
• Utilizes federal, state procedures/guidelines to assure accuracy of coding and abstracting
• Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation
• Maintains performance in accordance with corporate compliance requirements as it pertains to the coding and abstracting of medical records
• Sequences principal (or first-listed) diagnosis and principal procedures according to documentation found in the medical records
• Utilizes ongoing knowledge and reference material regarding DRGs to validate DRG assignments
• Verifies and/or abstracts required data into computer system according to procedure
• Participates in maintaining DNB and accounts receivable goal

HIM Coder, CCS Required

• Codes and abstracts hospital medical records (including Inpatients, Observation, Outpatient Surgery, Invasive Outpatients, and Emergency Department) for diagnostic and procedural coding
• Utilizes federal, state procedures/guidelines to assure accuracy of coding and abstracting and productivity standards
• Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation
• Maintains performance in accordance with corporate compliance requirements as it pertains to the coding and abstracting of medical records, as well as Diagnosis Related Group (DRG) assignment

HIM Coder – Part Time, CCS Required

• Responsible for abstracting clinical information and assigning CPT-4 and ICD-10 codes from medical records and documents to support physicians professional fees
• Abstract billing for outpatient evaluation and management codes, minor surgical procedure(s) and HCPCS (supplies and pharmaceuticals) codes from provider documentation
• Research simple coding/billing issues for the physicians to identify and recommend the most appropriate method of coding/billing
• Analysis of the medical record to determine the appropriateness of coding and potential patterns of abuse

Coder – Physician Practice, CPC Required

Auditor

• Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department.
• Performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders.
• Responsible for working with VMG practices to resolve all coding issues that prevent accounts from being processed appropriately.
• Responsible for developing, implementing and maintaining compliance plan for pro-fee coding and abstracting.
• Providing training and education for newly hired coders that includes utilizing the medical record in conjunction with rules and regulations to properly code VMG encounters.
• Conducting Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.
• Reviewing work queue edits for provider coding trends and education needs.
• Assisting with monitoring of pre-AR aging reports and troubleshooting and resolving complex problems

Coding Auditor, Educator

Manager

• Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes
• Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process
• Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity
• Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues
• Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers
• Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system
• Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process
• Prepares and facilitates audits using appropriate screening tools and documentation
• Accountable to job specific goals, objectives and dashboards which contribute to the success of the organization
• Participates in organizational improvement activities including patient satisfaction, Six Sigma committee, department and/or divisional teams and community activities
• Understands and applies applicable federal and state requirement
• Identify and reports compliance issues as appropriate

HIM Coder, CCS Required

HIM Coder – Part Time, CCS Required

Coder – Physician Practice, CPC Required

Coding Auditor, Educator

Outcomes Manager, Utilization Review – RN, Full Time