PB Coder III

JOB PURPOSE:

Responsible for coding and abstracting procedural (CPT) and diagnosis codes (ICD-10) for physician services, reviewing physician documentation in the electronic medical record for completeness and accuracy to ensure proper code assignment, providing physician feedback of discrepancies/trends, data input of encounters in the practice management system, resolving edits and denials, and releasing encounters for billing. Utilizes advanced problem-solving skills to address coding related tasks of high complexity. Requires advanced knowledge of all coding workflows including coding for surgical procedures for multiple specialties. Duties include Responsible for capturing services, reviewing physician documentation, CPT and ICD-10 coding, claim edit resolution, and coding denial management of coding related tasks. Assumes full responsibility for the charge capture, coding, and charge entry of all assigned surgical cases into the practice management system. Ability to translate operative notes into billable services. Monitors medical records to ensure documentation complies with hospital and payer policies and regulations. Educate physicians on proper documentation techniques and improvement opportunities. Collaborates with physicians to ensure timely completion of attestations in the medical records. Maintains working knowledge of payer specific coding guidelines, medical terminology, modifier usage, and NCCI edit conventions, as well as healthcare billing and reimbursement guidelines.

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MINIMUM EDUCATION REQUIRED:

High School Diploma/GED required. Coding Certificate program, AAPC or AHIMA accredited preferred.

MINIMUM EXPERIENCE REQUIRED:

Four (4) years of coding experience required, Two (2) years of experience must be in a Surgical/Ancillary Diagnostic discipline or 1 year of experience with specialty coding certification in a Surgical/Ancillary Diagnostic discipline. Knowledge of CPT and ICD-10 coding conventions.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

None

ADDITIONAL QUALIFICATIONS:

CPC, CCS, CPC-H, CCS-P, CCS-H, RHIA, RHIT, or equivalent coding certification required.

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KEY RESPONSIBILITIES:

1. Codes highly complex surgical, special procedures, observation records, inpatient records, medical, diagnostic, procedural, and/or recurring records within established productivity and coding accuracy guidelines. Highly complex surgeries may require research and reference checking to ensure accuracy of problematic coding.

2. Evaluates medical record documentation, paper charge, discharge disposition, ICD-10 and CPT coding to optimize reimbursement by ensuring that medical, diagnostic and procedural codes and other documentation accurately reflect and support the visit.

3. Compiles necessary documentation prior to coding review; when documentation is not available, performs the appropriate steps to obtain the necessary documentation per the department's policies and procedures.

4. Maintain the knowledge necessary to navigate the EeMR to efficiently perform tasks and meet production and quality standards.

5. Assist manager in training of subordinate coders and serves as the point person/lead for employee questions.

6. Works independently to resolve issues, applying root cause analyses to determine steps required for timely resolution. Meets established productivity and accuracy standards

7. Demonstrate the ability to communicate effectively and professionally in interactions with physicians, management, and staff.

8. Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes; offers physician opportunity to submit corrected documentation.

9. Notifies appropriate individuals of potential non-compliance with Medical Necessity requirements and when services are non-covered or not payable, as appropriate.

10. Corrects failed claim errors to billing edits, coding denials, quality management data edits and/or other errors identified through various auditing or billing process

11. Maintains professional growth by participating in educational programs and professional organization to stay abreast of code changes, trends, practices, and developments. Must meet all requirements to maintain coding certification.

12. Must be able to work collaboratively and positively within a culturally diverse production environment.

13. Performs other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES

* Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines.

* Knowledge of external auditing processes and third-party reviews.

* Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system.

* Knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to medical documentations, billing and coding; knowledge of subspecialty and surgical coding.

* Skill and ability to communicate effectively both orally and in writing.

* Skill and ability to research and analyze data, draw conclusions, and resolve issues.

* Skill and ability to read, interpret, and apply policies, procedures, laws, and regulations; read and interpret medical procedures and terminology; develop training materials; make group presentations; exercise independent judgment; and prepare reports and related documents.

* Skill and ability to maintain working relationships with physicians and other staff

* Skill and ability to review the work of others and maintain confidentiality.

* Knowledge of Standards of Ethical Coding.