Incumbents must be proficient with CPT and ICD-10-CM coding systems and are responsible for assigning ICD diagnosis codes and CPT procedure codes accurately and completely to ensure optimal reimbursement and coding quality. Coders in this position are held accountable for adhering to coding and compliance guidelines; and accounts must be coded and complete within timeframes specified by department leadership.
Incumbent must have and intermediate skill set to:
• Select correct code assignment by proficient analysis and translation of diagnostic statements, physicians’ orders, and other pertinent documentation.
• Code/Audit encounters within the Professional Services Coding Epic queues
• Complete accountable work related to daily unbilled charges to ensure timely billing in conjunction with billing and compliance guidelines.
• Address appeals and review documentation needed for insurance denials to facilitate expedient resolution and reimbursement.
• Work both in a team and individual environment, and is confident working with a wide variety of healthcare professionals.
• Identify and resolve problems, set goals and priorities, and represent the department in a professional manner as well as in the absence of Leadership, as assigned.
Incumbent must be knowledgeable in Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed. This position is challenged to stay abreast of the frequent changes in Federal and State regulations for professional fee billing and coding, stay informed of changes in treatment modalities and new procedures codes. Job responsibilities include accurate code assignment based on documentation and when documentation is incomplete, vague, or ambiguous, it is the responsibility of incumbent to work in conjunction with the department Leadership to utilize the appropriate provider clarification process to obtain additional information that provides a symptom or diagnosis and/or provider order. Other responsibilities include:
• Adherence to Professional Services Coding and Billing policies.
• Responsibility for maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory changes.
• Contacts the appropriate charging department for assistance in obtaining physician clarification of diagnosis and/or procedures.
• Participates in performance improvement initiatives as assigned.
KNOWLEDGE, SKILLS & ABILITIES
1. Knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’ Official Guidelines for Coding and Reporting ICD-10-CM coding.
2. Knowledge of Evaluation and Management Guidelines and auditing in order to provide information to Auditing Team to coordinate provider education and identify possible revenue opportunities.
3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
4. Knowledge of clinical content standards.
5. Knowledge of the appeal process in order to ensure accurate reimbursement.
This position does not provide patient care.