1B75
MEDICAL CODING CLERK

This is advanced level clerical work in the City's Health Department. Employees in this class are responsible for review and determination of appropriate classification codes, report generation, and record maintenance for a specialized support function. Work includes reviewing causes of death for the Mortality Records assignment; posting payments and reconciling billing errors for the Third-Party Billing assignment; processing vaccine orders and evaluating usage statistics for the Vaccination Control assignment. Contacting physicians and other health agencies to clarify and resolve discrepancies and keeping abreast of changes within the specific functional area are significant aspects of the work. Work is performed under the direct supervision of an administrative supervisor.

1. Employees in this class must perform a medical coding function in a centralized unit of the Health Department for mortality records, third-party billing, or vaccine control.

FOR ALL FUNCTIONS:

• Operates interactive personal computer; enters demographic and other medical information; extracts data from data base using non-procedural program language to compose statistical reports; devises format for reports; reviews quality of reports, correcting errors as needed before distributing; prepares weekly and monthly statistical reports for state and federal authorities; maintains a computer-generated mailing list to distribute statistical reports.
• Reviews information received for accuracy and correctness.
• Prepares queries to physicians and other medical sources to obtain clarification of information received.
• Contact providers, health centers, medical examiner, patients and various other sources to obtain information required to resolve discrepancies.
• Generates reports to correct coding errors.
• Performs related work as required.

FOR THE MORTALITY RECORDS CODING FUNCTION:

• Analyzes and determines whether classifications of the primary, contributing and underlying causes of death are compatible with one another.
• Provides proper coding for data from death certificates; attends international classification of disease training classes to keep abreast of classification techniques; trains clerical personnel in rules and procedures for coding causes of death and medical encounter forms.
• Participates in state and federal studies of assigned causes of death; aids other authorized departmental personnel and medical providers supplying them with copies of death certificates related to their program.

FOR THE THIRD PARTY BILLING FUNCTION:

• Posts payments received from health insurance providers for medical services provided by City health centers; utilizes electronic remittance to post Medicare, Medicaid, Blue Shield and other third-party commercial carrier payments; reviews Medicare and other insurance benefits reports to reconcile billing errors; identifies claims that were rejected due to billing or information errors; reviews denial codes to determine the specific reason claims were rejected.
• Generates reports on rejected claims and procedure code errors; analyzes and corrects the financial error report; performs mathematical computations to determine percentages paid by health insurance providers.
• Generates invoices for health care accounts receivable function; performs billing, posting and reconciliation activities.

FOR THE VACCINATION CONTROL FUNCTION:

• Reviews vaccine orders received from health care providers citywide for completeness and accuracy; analyzes and determines whether vaccine orders are compatible with vaccine usage data on individual provider basis; processes vaccine orders; contacts health care provider to resolve discrepancy prior to processing order.
• Operates automated vaccine management software program to order, track, and record costs of publicly funded vaccines ordered and used; submits vaccines ordered and used; submits vaccine orders electronically to the United States Public Health Service, Centers for Disease Control (USPHS, CDC) [source of these vaccines]; analyzes reports to identify resource wastage and shortfalls for program manager.
• Attends annual mandated training provided by CDC on all aspects of vaccine management, including immunization schedules storage and other requirements of vaccine management and software upgrades.

KNOWLEDGE OF:
• medical terminology and nomenclature
• medical coding procedures using ICD-9 manuals (International Classification of Diseases-9), if required by work assignment
• the objectives and procedures used in medical record-keeping systems
• interactive personal computer data entry and retrieval procedures
• basic arithmetic
• basic bookkeeping principles and practices
• standard accounting and/or billing procedures of the City, if required by work assignment
• packaging and storage requirements and indications for use of all childhood vaccines, if required by work assignment
SKILL IN:
• the proofing and verification of machine and computer-produced statements
• the operation of an interactive personal computer
ABILITY TO:
• learn the principles of classifying vital statistics according to complex coding systems
• learn diagnosis and procedure codes associated with medical billing, if required by work assignment
• learn the methods and principles used to rank importance of multiple causes of death, if required by work assignment
• learn the childhood immunization schedule and principles of immunogenecity, if required by work assignment
• learn one or more non-procedural program languages
• prepare statistical reports
• maintain favorable working relationships with representatives of outside agencies, professional and medical personnel, health insurance providers, and other employees
• express comments and opinions clearly and concisely in oral and written form
• read, understand and interpret health care and health insurance data
• learn the various regulations related to work assignment

EDUCATION
• Education equivalent to completion of the twelfth school grade, which has included federally mandated training in methodologies appropriate to the work assignment.
AND
GENERAL EXPERIENCE
• Two years of experience at the Clerk 2 level or above.
AND
SPECIFIC EXPERIENCE
• One year of full performance level clerical experience in the Health Department performing work in a centralized billing and reimbursement unit, using SMS-software, or performing complex interpretations and determinations of chains of causality for deaths in a centralized mortality records unit, or performing an inventory control function in a centralized vaccine unit.

• Ability to physically perform the duties and to work in the environmental conditions required of a position in this class.