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.
The Medical Coder Specialist will have frequent and daily interactions with internal and externalclients including but not limited to Physician and
Non-physician OB/GYN Providers. Responsibilities include diagnosis and procedural coding for the designated major surgical specialty areas and other procedural areas including capture of professional services provided and reconciliation of all surgical or procedural cases performed a teach hospital where applicable. The Medical Coder Specialist focuses their work on detailed physician procedural chart abstraction as well as serves as a liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes. Surgical and/or procedural abstraction coding is defined as code assignment based solely on the source documentation for CPT-4 and ICD-10-CM respectively.
Duties and Responsibilities:
Primarily code from final procedural/surgical operative reports signed by the provider. Review complex medical records and accurately assigns codes for primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT-4 coding conventions. Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and procedural/surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guide lines to inpatient and outpatient diagnoses and procedures. Correlate information from approved supporting clinical documentation not limited to Pathology,Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.
Provide education/training to physicians and other providers on coding and clinical documentation. Consult with and educate/train physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to procedural/surgical providers as it pertains to proper coding and clinical documentation of services performed. Engage in provider/department contact and education as the primary liaison for clarification of documentation and coding for defined surgical operative cases including documentation deficiencies.
Mentor and assists in training of other coders within the department. Participate in the development of coding policies and procedures as identified. Coordinate/mentor the work of designated coding employees to ensure quality and quantity of work performed through regular audits. Assist with research and development of presentation materials for continuing education programs for physician in their areas of specialization.
Interact with and provides high-level analysis of trends to Management, Revenue Managers and others about coding related issues. Researches and identifies trends in unbilled accounts. Contacts appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures w/ providers, revenue managers, and management. Collaborate with appeal and edit coders to expedite resolution of accounts. Use authorized resources and systems to aid in accuratecode assignment for physician and non-physician documentation and surgical abstraction. This may include but not limited to review of NCCI Edits, LCD's,NCD's, use of nThrive, and other reputable coding references
Perform other related duties 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.). OB/GYN experience preferred.
Degrees, Licensures, Certifications
Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or other coding certificate.
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