230 Highland Ave.
Somerville,
MA
02145
US
| Fully Remote
TELECOMMUTE
US
Posted: 06/02/23
2023-05-22
2023-07-02
Category: Healthcare IT, Other, Professional
Job Number: 21222
Job Description
Position: Certified Professional Coder
Location: Remote
Job Type: Contract to Hire
Duration: 6 months to start
Job Description
The department provides critical oversight of the revenue cycle for the client including actively participating in front end and back end processes.
Summary:
Working under the direction of the Coding Services Manager and exercising independent judgment within the scope of their professional practice, the Certified Professional Coding & Billing Specialist performs a variety of tasks associated with coding physician and other provider charges, and providing coding education to providers in that area.
Duties include hands-on coding, documentation review, coding dictionary updates, resolving rejections and denials via appeal and/or adjustment, surgical coding, physician or other care provider education, and other coding needs for ICD-9, ICD-10 and CPT coding of inpatient and outpatient professional charges.
Responsibilities:
Coding Responsibilities:
• Provides review and/or coding of any professional services including but not limited to surgeries, encounters, and diagnostic services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, and Modifier usage/linkage as well as provide ICD-9 and/or ICD-10 coding where needed for handwritten/missing diagnoses. Provides same for areas where work files are used. In areas where paper is used, reconcile daily charges against log (if available/applicable) to ensure daily capture of coding charges expected. Productivity and accuracy for work file and non-work file standards must be met according to guidelines set by manager.
• Review and assist in updates of coding dictionaries/encounter forms/charge slips as needed for accuracy of CPT, HCPCS and ICD-9 & ICD-10 Coding.
• Periodic review of codes, at least annually or as introduced or require for new, revised, or deleted code updates.
• Answers and responds accurately and timely to questions on the telephone, voice mail, e-mail, Coding Hotline and/or Coding Website as appropriate.
• Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections to appropriate parties. Resolves claims by processing necessary appeals accordingly.
• Reports regularly on daily activity, productivity, and findings of reviews/rejections/education via electronic file or database, e-mail, paper, or other means as required by manager.
Physician/Provider Education:
• Confers regularly with physicians/care providers, clinical or ancillary managers, coders, or other staff through departmental staff meetings, one-on-one meetings, and/or daily interactive communication to respond to and educate providers on specific departmental and clinic wide coding issues and updates including but not limited to the coding hotline and/or the coding website.
• Participates in new physician/care provider orientation as well as provide follow-up reviews and education for the new physician/care provider if applicable for the area of responsibility.
• Provides feedback, recommendations, and participates as the coding representative for the Professional Coding Department on the Revenue Cycle Teams as requested by manager.
• Develops and conducts a schedule of physician/care provider documentation reviews in areas where applicable and/or as defined by manager.
• Provides feedback to the physician/care provider, Department Chair, and/or Administration as required.
• Documentation review is ongoing and feedback will be provided to the physician/care provider, Department Chair, and/or Administration as required.
• Education & Professional Development:
• Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD’s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
• Communicates new guidelines to providers through physician/care provider and/or departmental meetings.
• Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
• Recommends updates/additions/deletions to the Coding Library as changes / regulations require.
• Organizational Requirements:
• Maintains strict compliance with Policies and Procedures. Incorporates Guiding Principles, Mission Statement and Goals into daily activities.
• Complies with behavioral expectations of the department and company.
• Maintains courteous and effective interactions with colleagues, providers and patients.
• Demonstrates an understanding of the job description, performance expectations, and competency assessment.
• Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
• Participates in departmental and/or interdepartmental quality improvement activities.
• Participates in and successfully completes Mandatory Education.
• Maintains minimum certification requirements for coding.
• Performs all other duties as needed or directed to meet the needs of the department.
MINIMUM QUALIFICATIONS:
- Education: High School Diploma or equivalent, plus additional specialized training associated with attainment of a recognized Coding Certificate.
- CPC (Certified Professional Coder through American Academy of Professional Coders) or CCS-P (Certified Coding Specialist Physician based through American Health Information Management Association) is required.
- Computer skills: Proficient in Microsoft Office (Word, Outlook, Access, and Excel). AthenaNet, Meditech and/or Epic systems experience preferred.
- Work experience:
- Minimum 2 years Professional Coding experience in conjunction with requirements indicated above; or 4+ years coding or related experience in a private practice.
- Ideal candidates should have experience in professional coding, claims management, denials, and appeal processes. Those considered for this position should be highly organized, self-motivated and have demonstrated critical thinking skills. The ability to communicate effectively and to portray a professional image is essential.
- Candidates must be able to read and interpret an EOB (Explanation of Benefits), Remittance Advice and CMS 1500 data elements. They must have working knowledge of the CPT and ICD-9/ICD-10 guidelines. Also required to identify managed care denials and understand contract reimbursement.
- Demonstrates a thorough understanding of the body of knowledge required for attainment of a college-level coding certificate as indicated above.
- Knowledge of research techniques to collect, analyze and interpret data and make recommendations.
- Knowledge of legal and fiscal requirements and regulations.
- Strong knowledge of finance and accounting computer systems, spreadsheets (Excel), databases (Access) and other applications.
- Knowledge of claims management, denials and appeal processing.
- Knowledge of medical terminology and professional coding methodologies to include DRG, RBRVS, CPT, HCPC and ICD coding principles and code-sets.
- Skill in problem recognition, escalation and resolution.
- Skill in interpreting and analyzing financial data and reports.
- Skill in examining documents and interpreting their accuracy.
- Skill in both verbal and written communication.
- Skill in effectively communicating with all levels of management and physicians.
- Skill in establishing and maintaining effective working relationships.
- Skill in preparing and effectively presenting financial information.
- Ability to exhibit a high degree of individual initiative, independent judgment and effectively articulate thoughts and conclusions.
- Ability to prepare and analyze claims detail to identify trends and/or root cause.
- Ability to develop coherent presentations of results
- Ability to perform mathematical and statistical computations quickly and accurately.
- Ability to work with business computer applications, spreadsheets and databases.
- Ability to effectively communicate and educate others in sharing knowledge and providing direction within the scope of the job.
#LI-Remote
Queen Consulting Group is an equal opportunity employer. Our goal is to promote an environment that helps our employees and clients appreciate the benefits that diversity provides.
