Key Responsibility Areas (KRA) & Key Performance Indicators (KPI) for Certified Medical Coder
1. Coding Accuracy
KRA: Ensuring accurate assignment of medical codes for billing and reimbursement purposes.
Short Description: Precision in assigning medical codes.
- KPI 1: Coding Error Rate
- KPI 2: Claim Rejection Rate
- KPI 3: Audit Findings Rate
- KPI 4: Accuracy in DRG Assignment
2. Timely Billing
KRA: Submitting claims promptly to facilitate timely reimbursement.
Short Description: Timeliness in claim submission.
- KPI 1: Average Billing Cycle Time
- KPI 2: Percentage of Claims Submitted Within 48 Hours
- KPI 3: Rejection Resolution Time
- KPI 4: Days Sales Outstanding (DSO)
3. Compliance Adherence
KRA: Ensuring compliance with coding guidelines and regulations.
Short Description: Adherence to coding standards.
- KPI 1: Compliance Audit Results
- KPI 2: Training Completion Rate on Regulatory Updates
- KPI 3: Accuracy in ICD-10-CM/PCS Coding
- KPI 4: Adherence to HIPAA Guidelines
4. Productivity and Efficiency
KRA: Maintaining high productivity levels while ensuring quality.
Short Description: Efficient and effective coding processes.
- KPI 1: Average Coding Cases Completed Per Day
- KPI 2: Time Spent on Average on Each Case
- KPI 3: Rate of Coding Backlogs
- KPI 4: Utilization of Encoder Software
5. Denial Management
KRA: Analyzing and resolving claim denials to minimize revenue loss.
Short Description: Effective denial resolution strategies.
- KPI 1: Denial Rate Reduction
- KPI 2: Recovery Rate of Denied Claims
- KPI 3: Denial Trends Analysis
- KPI 4: Appeals Success Rate
6. Continuous Learning and Development
KRA: Engaging in ongoing education to stay updated on coding changes.
Short Description: Commitment to professional growth.
- KPI 1: Participation in Continuing Education Programs
- KPI 2: Certification Renewal Rate
- KPI 3: Performance in Coding Competency Assessments
- KPI 4: Implementation of Learnings in Practice
7. Quality Assurance
KRA: Implementing quality control measures to ensure coding accuracy.
Short Description: Focus on maintaining high-quality standards.
- KPI 1: Internal Quality Review Scores
- KPI 2: Peer Review Feedback Incorporation Rate
- KPI 3: Identification and Resolution of Coding Discrepancies
- KPI 4: Adherence to AHA Coding Clinic Guidelines
8. Team Collaboration
KRA: Collaborating effectively with healthcare providers and billing teams.
Short Description: Building strong cross-functional relationships.
- KPI 1: Communication Effectiveness with Providers
- KPI 2: Resolution Time for Coding Queries
- KPI 3: Teamwork Ratings from Colleagues
- KPI 4: Interdepartmental Coordination Efficiency
9. Revenue Optimization
KRA: Identifying opportunities to maximize revenue through accurate coding.
Short Description: Focus on revenue enhancement strategies.
- KPI 1: Increase in Average Reimbursement Per Claim
- KPI 2: Revenue Recovery Rate from Previously Denied Claims
- KPI 3: Coding Contribution to Revenue Growth
- KPI 4: Identification of Undercoding/Overcoding Instances
10. Data Analysis and Reporting
KRA: Analyzing coding data to generate insightful reports for performance evaluation.
Short Description: Utilization of data for informed decision-making.
- KPI 1: Timeliness of Monthly Reports Generation
- KPI 2: Accuracy of Code Utilization Reports
- KPI 3: Utilization Rate of Data Analytics Tools
- KPI 4: Actionable Insights Derived from Data Analysis
