POSITION DESCRIPTION:
Reviews evaluation and management codes, modifiers, procedures, injections and diagnosis codes entered by physicians to ensure correct coding was entered by the physician. Facilitates appropriate billing for inpatient, outpatient, ER and special procedures, such as, but not limited to, OB deliveries, by reviewing the physician’s documentation to substantiate the level of coding. Physician services include identification of professional services in, and complete review of, medical records to accurately optimize all professional services documented for billing.
ESSENTIAL JOB FUNCTIONS:
The following job functions may not be the responsibility of all Certified Coding Specialist I’s. Some Certified Coding Specialist I’s will be assigned work that has more focused responsibilities.
- Review’s warnings/errors in EPIC that are triggered when inappropriate code or modifier combinations are used.
- Maintains complete knowledge and complies with all relevant insurance, CPT coding and diagnosis guidelines, disseminating information to staff and providers as necessary.
- Verifies provider chosen codes for non-invasive procedures.
- Runs daily reconciliation reports to ensure all charges are captured for each H&P, consult and discharge summary note entered into EPIC by physicians.
- Maintains query communication with providers to ensure timely notification of identified documentation issues that may impact revenue or compliance.
- Attends meetings with physicians and other clinical staff as required. Attends other regularly scheduled meetings.
- Creates relationships with external organizations that allow for streamlining and quick resolution of billing matters for patients.
- Coordinates and follows through with special projects as assigned.
- Performs other duties as assigned.
ORGANIZATIONAL EXPECTATIONS:
- Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
- Must be able to work effectively as a member of the Revenue Site Operations team.
- Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
- Maintains knowledge of and complies with IHA standards, policies and procedures.
- Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
- Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
- Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
- Uses resources efficiently.
- If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.
MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: High School Diploma or GED.
CREDENTIALS/LICENSURE: One of the following certifications is required: AAPC (CPC, CPC-A), PMIC (CMC), AHIMA (CCS-P).
MINIMUM EXPERIENCE: 2 years’ experience in a healthcare setting.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
- Familiarity with billing and managed care department basic services and hours of operation to respond to customer requests accurately.
- Knowledge of medical, including surgical, terminology and procedures at the level needed to perform job responsibilities, including understanding of CPT and ICD-9/ICD-10 coding.
- Proficient/knowledgeable in the rules and regulations regarding insurance claim submission.
- Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.
- Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to speak before groups of people, either in-person or virtually.
- Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
- Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, insurance carriers, outside customers, vendors and couriers.
- Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
- Good organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work.
- Ability to exercise sound judgement and problem-solving skills, specifically as it relates to resolving billing and coding problems.
- Ability to handle patient and organizational information in a confidential manner.
- Ability to work either remotely or in-office, as needed.
- Ability to drive to other office/practice sites and meeting and training locations.
- Ability to work under minimal supervision.
- Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
- Physical activity that often requires keyboarding, filing and phone work.
- Physical activity that often requires extensive time working on a computer.
- Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.
- Physical activity that sometimes requires lifting, pushing and/or pulling under 20 lbs.
- Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
- Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job is mainly remote, there will be times you will be expected to come into the office and adequate notification will be given.
When working in-office, the job operates in a typical office environment which involves frequent interruptions and significant interaction with people, which can be stressful at times.
