Senior Professional Services Coder

Position Purpose

This position is accountable for the initial and ongoing success of workflows for all Professional Services Coders. This position will provide support and needed assistance for department members to ensure professional coding is accurately done within quality metrics and appropriate timelines. This position is responsible for keeping abreast of current continual changes in coding and billing guidelines and compliance related to reimbursement within Federal and State regulations for billing and reimbursement.

Nature and Scope

Incumbents must be proficient with CPT and ICD-10-CM coding systems and responsible for assigning ICD-10-CM diagnoses 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 guidelines; accounts must be coded within the quality and productivity standards specified by department leadership.

Incumbent is responsible for abstracting, analyzing, and assigning ICD-10-CM, CPT, HCPCS codes and appropriate modifiers for evaluation and management (E/M), minor procedures, and diagnostic tests by using either computerized or manual systems. Researches and resolves coding and reimbursement issues to ensure the accuracy, quality, and integrity of coding practices. Other responsibilities include:

• Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.

• Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.

• Able to accurately abstract information from the medial records into the abstract system, according to established guidelines.

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines.

• Enters and validates codes, charges and other edits flagged in EPIC for review.

• Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units)

• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity.

• Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.

• Meet and/or exceeds the established coding productivity standards.

• Effectively communicates with clinicians and billing/coding teams regarding code changes and denials.

• 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.

• Acts as a mentor to associate and mid-level coders.

• Prepares and presents education in staff level meetings.

• Assist with new coder onboarding training.

KNOWLEDGE, SKILLS & ABILITIES

1. Knowledge of Anatomy and Physiology, Pharmacology, Disease Pathology, and Medical Terminology.
2. Knowledge of modifiers, ICD-10-CM, CPT (including E/M) and HCPCS coding.
3. Knowledge of Evaluation and Management Guidelines and auditing to assist in provider education and identifying possible revenue opportunities.
4. Conversion of written description to proper billing codes.
5. Ability to appeal CPT and ICD-10-CM for maximum reimbursement.
6. Utilize critical thinking and problem-solving abilities.
7. Comprehension of disease processes.
8. Ability to work well with others.
9. Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges.
10. Uphold a strong work ethic characterized by honesty and dependability.
11. Demonstrate personal time management skills, including organization, prioritization, and multitasking.
12. Adherence to company policies, procedures, and directives.

Shift: Wednesday through Sunday - must be able to work between the business operation hours of 6am-6pm PST.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications