Job Family Description
Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of
clinical care.
Job Function Description
Jobs in this function provide coding and coding auditing services directly to providers. This includes the analysis and translation of
medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes.
General Job Profile
– Extensive work experience within own function.
– Work is frequently completed without established procedures.
– Works independently.
– May act as a resource for others.
– May coordinate others activities.- Extensive work experience within own function.
– Work is frequently completed without established procedures.
– Works independently.
– May act as a resource for others.
– May coordinate others activities.
Job Scope and Guidelines
– Applies knowledge/skills to a range of moderately complex activities.
– Demonstrates great depth of knowledge/skills in own function.
– Sometimes acts as a technical resource to others in own function.
– Proactively identifies solutions to non-standard requests.
– Solves moderately complex problems on own.
– Works with team to solve complex problems.
– Plans, prioritizes, organizes and completes work to meet established objectives.
– May coordinate work of other team members.
Additional Scope and Guidelines
Not Applicable
Minimum Educational Background
– High school education or equivalent experience.
Licenses and Certifications
Code Description
Functional Competencies
Functional Competency & Description Proficiency Level
MCD_Translate Medical Terminology into Medical Codes
C) Fully Proficient
-Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and
make determinations or identify appropriate medical codes
-Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code
applicability, rules, and guidelines
-Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary
services) to assign appropriate medical codes
-Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes
-Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information
-Follow up with providers as necessary when responses to queries are not provided in a timely basis
-Utilize medical coding software programs or reference materials to identify appropriate codes
MCD_Make Medical Coding Determinations
C) Fully Proficient
-Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)
-Apply post-query response to make final determinations
-Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process
-Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical
code determinations.
-Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing
medical records (e.g., charts, assessments, visits, encounters)
-Provide information or respond to questions from medical coding quality audits
-Perform medical coding audits to evaluate medical coding quality
-Review medical coding audit results
-Follow steps per agreement with medical coding audit results to resolve discrepancies
-Provide resources and information to substantiate medical coding audit findings
-Educate and mentor others to improve medical coding quality
MCD_Demonstrate Coding-Related Business and Technical Knowledge
C) Fully Proficient
-Apply understanding of National Correct Coding Edits to the coding process
-Demonstrate understanding of National and Local coverage determinations
-Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
-Follow relevant professional code of ethics consistent with required certifications
-Attain and/or maintain relevant professional certifications and continuing education seminars as required
-Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with
others
-Utilize and navigate across clinical software applications to assign medical codes or complete reviews

Minimum Educational Background
– High school education or equivalent experience.


Source link