Provide leadership and direction for functions related to Professional Coding Denials, Professional Coder Training and Auditing. Highly accountable for attainment of organizational goals and sets the organizational direction for professional coding denials and clinic coder training.
PRIMARY RESPONSIBILITIES AND DUTIES: (This list may not include all of the duties assigned.)
- Serve as a resource for providers in understanding covered indications and the supporting documentation. Supports both technical and professional services in provider clinic.
- Conveying coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation.
- Accountable for developing and maintaining applicable coding policies with BC internal initiatives as well as regulatory rules.
- Serve as the primary mentor/trainer to internal coders and provide educational feedback and instruction to staff for coding guidelines as part of the internal quality review.
- Plans and conducts audits and reports on the documentation, coding and billing performed. Reviews, develops and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external audit findings and responds as needed.
- Remain current in coding schemes and knowledge of prospective payment systems and clinical practices and technology.
- Understanding of intermediary auditing related to payer mix. Possess extensive knowledge of coding systems.
- Maintains a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units as appropriate for the role.
- Understands and supports the Medicare and Commercial Carrier workflows related to daily coding and denial review and appeals management, including the preparation of supporting documents and information to support the appeal process.
- Monitors and validates physician charge capture.
- Reviews medical documentation from physicians and other healthcare providers; assigns modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards.
- Uses relevant policies, procedures, and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
- Provide accurate and timely international classification of disease – tenth edition – clinical modification (ICD-10) - CM coding of diagnoses, Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding, and in accordance with official coding standards, regulatory coding compliance guidelines and company procedures.
- Review and audit medical record documentation accurately to reflect healthcare coding and to substantiate appropriate service reimbursement.
- Self-motivated with the ability to work independently, multi-task, problem solve and make informed and accurate recommendations to medical professionals based on current information.
- Demonstrated leadership skills and proven ability to effectively train others and motivate people in realizing and attaining their goals.
- Good written and verbal communication skills. Ability interact with others. Thoughtful dialogue and inquiry discussion experience.
The aforementioned statements reflect the general duties that are necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent in the position.
Associate degree in Health Information Technology or Certification in Coding required or within one year of date of hire.
Specific knowledge of diagnostic and procedural terminology, successful coursework from an accredited institution in International Statistical Classification of Diseases (ICD) diagnosis, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) coding schemes, medical terminology or human anatomy/physiology is preferred.
If the associate is not certified at hire, the associate must be so within one year of the date of hire. Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Professional Coder-Apprentice (CPC-A), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS-P), CCS Healthcare (CCS-H), Certified Outpatient Coder (COC).
Typical physical demands: Sedentary work involves sitting most of the time. Occasionally lifts and carries items weighing up to 30 pounds. Requires repetitive movements of the wrists, hands and/or fingers, the ability to receive and express detailed information through oral communication, visual acuity, and the ability to read and understand written directions.
APPLY NOW - To apply for a position(s), complete one of the following options: Online Application, PDF Application or Word.DOC Application. For more information on becoming a member of the Brown Clinic team, contact Human Resources at 605-884-4247 or click here.