Position Summary/Career Interest
The primary functions of this position are to provide staff support for coding of charges with CPT, ICD-10 and HCPCS and to be a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician billing.
- Reviews outpatient/inpatient EHR for appropriate documentation and signatures, and reviews interface charges prior to billing. Reviews departmental reporting structures and requests modifications as needed, i.e. adding billing areas, providers, etc. Monitors CPT, ICD-10, and HCPCS code changes. Codes diagnosis for specialty/surgical accounts using ICD-10 nomenclature. Codes physician's specialty/surgical procedures using CPT codes. Interface charges are then released through the billing system. Paper charges are keyed and released through the billing system.
- Reviews coding by physicians and suggest possible modification of codes to maximize reimbursement. Reviews reimbursement from third-party payers to ensure payment through proper use of codes.
- Identifies and resolves potentially troublesome service/billing areas such as continuity of care, discharge summaries, admission history and physicals and consultations.
- Mentor and assists in training of other coders within the department.
- Participate in the development of coding policies and procedures as identified.
- Works denied claims.
- Identify unspecified diagnosis used and determine if documentation supports a more specific diagnosis
- Provide education/training to physicians and other providers on coding and clinical documentation.
- Review the complex (problematic coding that needs research and reference checking) medical records and accurately codes the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
- Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
- Provide real-time feedback to surgical/procedural providers as it pertains to proper coding and clinical documentation of services performed.
- Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
- Note: These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.
- High School Diploma or GED
- 3 years of specialty and surgical coding experience
- Familiarity with data processing applications in a Windows environment, especially in the health care accounts receivable area.
- Knowledge of medical terminology, billing procedures, medical insurance.
- CPC, COC, CIC or CCA