Multi Specialist Coding Assoc III

The Professional Services Coder will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance). Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting. 

Responsibilities: 

• 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 Athena or 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 
• Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards 

Required Qualifications: 

• High School Diploma or GED required CCS-P, CPC 
• Two (2) years experience in Multi-Specialty coding
• Experience in coding Ortho, GI and surgical
• Must be able to demonstrate proficiency in professional services (95% accuracy). 
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (ie:  Documentation Guidelines ’95 & ’97) 
• Extensive knowledge of government, and commercial payer guidelines. 
• Must be able to use standard office equipment and information systems. 
• Ability to interact with other employees through effective communication. 
• Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals