Coding and Documentation Specialist, ProHealth

Wendy is a Medical Coding Specialist and a Clinical Documentation Improvement Specialist with the health information company, Pro Health. Coming from a previous career in a clinical setting, Wendy now has the freedom to work from home in a rewarding career that blends her clinical health background with coding and information technology.

Transcript

>> My name is Wendy Rush and I am a clinical documentation improvement specialist and a medical coder. Well, I start my day off by logging into an electronic health record and from there I go admission office visit encounters. And from the office visit encounters I am wading through documentation and I am looking for the diagnoses and the procedures that I can pull out from that documentation to assign in an encoder system that goes directly into the electronic health record. And I also have to make sure that I'm assigning an E and M level of service for the provider and I am making sure that all labs, and x-rays, and orders are in. And then I'm educating the providers on improvement in their clinical documentation. Well, I am given a work computer. I have two monitors. I log in and I punch in just like anyone else, 7:30 to 4:00 I work. And I just do what I would do in an office but I'm doing it from home so because we have the privilege of being connected to an electronic health record so everything goes into one place. Any time you go to visit your doctor and/or you go to have surgery, there would be an encounter made for that. And then the doctor would document what happened at that encounter. And then they would put that into your medical record. And then I would open up this work queue and I would pick out the clinical pieces from that and then assign the codes that would go on your bill.

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