Professional Services Coder
Renown Health
- New York, New York, United States
- New York, New York, United States
About
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.
Knowledge, Skills & Abilities Knowledge of Anatomy and Physiology, Pharmacology, Disease Pathology, and Medical Terminology. Knowledge of modifiers, ICD-10-CM, CPT (including E/M) and HCPCS coding. Knowledge of Evaluation and Management Guidelines and auditing to assist in provider education and identifying possible revenue opportunities. Conversion of written description to proper billing codes. Ability to appeal CPT and ICD-10-CM for maximum reimbursement. Utilize critical thinking and problem-solving abilities. Comprehension of disease processes. Ability to work well with others. Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges. Uphold a strong work ethic characterized by honesty and dependability. Demonstrate personal time management skills, including organization, prioritization, and multitasking. Adherence to company policies, procedures, and directives. This position does not provide patient care. Minimum Qualifications Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. High School Diploma/GED required. Experience: A minimum of 2-5 years previous pro-fee coding experience required. Experience in medical billing, and Professional Billing EMR workflows is preferred. License(s): None. Certification(s): CCS, CCS-P, CPC, COC and/or CIC Coding credential required. (Excludes apprenticeship classification) Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, Power Point, Excel, and Word. Must have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
Languages
- English
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