Job Summary:
Position is responsible for coding of physician and/or mid-level provider professional services. Recognize and complete a high-volume workload accurately and in a timely manner, with minimal direct supervision. Follow set procedures to achieve goals. Display professional office skills and ability to navigate a practice management system. Good written and oral communication skills, ability to handle multiple tasks, and work with and train other employees. Ability to serve as liaison between management, the physician practices, and employees working within physician practices.
This position is involved in a team-based approach to care. Team members are trained to meet the highest level of function for their role as per the State of Tennessee/Georgia guidelines.
Coder will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties. Specialties could include UR, Podiatry, Plastics, Pediatrics, OB, Pain Management, Ortho, Addiction, General Surgery, Internal Medicine, Urgent Care, Pulmonary, or ED. Facility Chart types could include OT, PT, Urgent Care, ED, or a variety of other specialties.
Services can include office visits that may include basic injections, diagnostic tests, physical/occupational/speech therapy, hospital rounding visits.
Responsibilities Include:
- Review and analyze information available in the electronic medical record and/or paper record to accurately code the episode of care in multiple specialty areas.
- Provide various components of coding services to support our providers.
- Calculate ProFee and/or Facility E/M levels by following the AMA guidelines for E/M assignment.
- Recognize critical care cases by patient acuity.
- Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
- Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, CPT�, and HCPCS
- Interpret coding guidelines for accurate code assignment
- Maintain an understanding of National Correct Coding Initiatives, Local Coverage Documents, MUE�s, and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers
- Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
- Align conduct with AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct and support the Company's Ethics and Compliance Program.
- Adherence to Det Norske Veritas (DNV) and other third-party documentation guidelines in an effort to improve upon any areas of risk
- Continually improve coding quality and accuracy.
- Responsibility for maintaining coding certification and knowledge referencing current ICD-10-CM, CPT and/or HCPCS coding guidelines and regulatory changes.
- Contacts the appropriate department or physician office for assistance in obtaining physician clarification of diagnoses, CPT, and/or HCPCS.
- Communicates with physician and non-physician providers to resolve conflicting provider documentation to further specify coding of diagnoses, surgeries and procedures documented in the medical record.
- Provides ongoing feedback to physicians and other providers during charge review
- Review and correct EPIC coder claim edits and eValuator edits as needed
- Resolves payer denials and responds to inquiries from revenue cycle teams, and processing of charge corrections as appropriate.
- Remain current on 3rd party payor reimbursement issues, Comply with all internal policies and procedures.
- Actively participate in Company provided training and education.
- Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information
- This position must consistently meet or exceed productivity and quality standards as defined by department Leadership
Education:
Required: High School Diploma or equivalent.
Preferred: Validation of coding certification, i.e., specialty focus such as ICD-10 coding, ICD-10 PCS, CPT coding, and billing practices from an accredited program.
Experience:
Required: Must demonstrate knowledge of coding to support this position. Must be able to work well with people. Ability to follow standard practices in coding and reimbursement. Requires high level of concentration for extended periods of time. Data entry proficiency required. Software/computer experience and/or training. Strong PC experience utilizing Excel, MS Word and Adobe.
Preferred: 1-year professional coding experience in a physician office or facility.
Position Requirement(s): License/Certification/Registration
Required: None, but ability to achieve a coding credential within 1 year of accepting position. Training will be provided.
Preferred: RHIT, RHIA, CCA, CCS, CPC, or CPC-H
CBCS is grandfathered in for staff currently working for Erlanger.
Department Position Summary:
The employee must demonstrate the knowledge and skills necessary to optimally code professional office, inpatient and outpatient facility encounters, as well as resolution of billing issues related to accurate coding. The employee must demonstrate knowledge of insurance reimbursement requirements. Must demonstrate the ability to work in a team by taking and giving direction and sharing in the responsibility of meeting team goals. Must have strong communication, critical thinking and decision-making skills.
The employee must display the ability to be self-motivated, be able to evaluate the scope of each day's work, and display time management skills to assigned work. Must be able to work effectively in a remote work capacity. The associate must provide management with annual/biannual proof of certification and complete annual/biannual required continuing education. This position must consistently meet or exceed productivity and quality standards as defined by department Leadership.
The associate will perform any other tasks as assigned.
