Medical Coder
Competency-based
ONET: 29-2071.00
1
Years
23
Skills
416h
Related instructions
Classroom instruction topics
- Certified Professional Coder Preparation Course
- Introduction to Human Anatomy & Medical Terminology
On-the-job training
- Properly applies diagnosis and procedure codes to medical charts, records and related documents
- Enters or confirms code(s) associated with medical diagnosis(es), procedures, and services
- Ensures medical codes reflect medical record documentation
- Supports documentation of care for services provider reimbursement process to ensure timely and accurate payment
- Ensures accuracy of diagnosis/procedural groups such as DRG (Diagnosis Related Group), MSDRG (Medical Severity), APC (Ambulatory Payment Classification), etc.
- Communicates with physicians or other care providers to ensure appropriate documentation
- Applies policies and procedures to comply with changing regulations among various payment systems for healthcare services, such as Medicare, Medicaid, managed care, etc.
- Applies policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery
- Supports accurate billing through coding, charge master, claims management and bill reconciliation processes
- Ensures accuracy of diagnostic/procedural groupings such as DRG and APC
- Resolves discrepancies between coded data and supporting documentation
- Submit claim forms in a timely manner. Evaluate and respond to claim denials.
- Apply outpatient coding guidelines appropriately
- Use and Understand format, conventions, guidelines, and rules of ICD-10-CM Diagnostic and procedural coding, coding of insurance forms ICD-10-Cm & CPT, process & complete all insurance forms, codes diagnoses and procedures.
- Maintains accurate and complete patient health records
- Compiles patient data and performs data quality reviews to validate code assignment and compliance with reporting requirements
- Ensures that medical records are complete, including medical history, care or treatment plans, tests ordered, test results, diagnosis & medications taken
- Verifies consistency between diagnosis and treatment plans, procedures and services
- Ensures compliance with healthcare law, regulations and standards related to information protection, privacy, security and confidentiality
- Participates in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training
- Validates coding accuracy using clinical information found in the health record
- Adheres to current regulations and establish guidelines in code assignment (focus on assignment of principle diagnosis, principle procedure, and sequencing as well as other clinical coding guidelines
- Uses established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative and others
- Maintains appropriate technology solutions including health information systems to support health care delivery and organizational priorities
- Specifies, refines, updates, produces and makes available a formal approach to implement information and communication technology solutions necessary to develop and operate the health information system architecture in support of the organization
- Stays apprised of innovative solutions for integration of new technology into existing products, applications or services
- Identifies and clarifies user needs (internal and external customers) and organizational policies to ensure system architecture and applications are in line with business requirements
- Uses and maintains applications and processes to support other clinical classification and nomenclature as appropriate (e.g. DSM-V - Diagnostic and Statistical manual of Mental Disorders - SNOMED-CT - Systemized Nomenclature of Medicine -Clinical terms,
FIND APPRENTICESHIPS BY STATE
AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWashington D.C.West VirginiaWisconsinWyoming
Made in the USA.