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Medical Records and Health Information Technicians and Medical Coders

Published
Competency-Based Apprenticeship
Sponsoring Company:
Urban Institute
O*Net Code
29-2072.00
Rapids Code
1114CB
Req. Hours
0
State
DC
Created
Jul 29, 2021
Updated
Jul 29, 2021

Competency-Based Skills

4 skill sets | 16 total skills
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
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 and 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

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