Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Working in collaboration with Coding Leadership for PB, medical group leadership, finance and clinical support staff, and other revenue cycle leadership.
- Conducts coding research for professional-based and hospital-based coding related current topics, reviewing organizational policy, government policy and coverage guidelines on appropriate subject matter. Creates documented recommendations based on the findings.
- Refers to HB coding guidelines, received from HB coding team, to supply codes to internal and external sources as requested.
- Develops, revises and maintains PB coding guidelines using template standardized documents. Bases coding guidelines and revisions on ICD, CPT and HCPCS coding information, in addition to other coding resources and references.
- Researches and provides detailed information on coding and reimbursement for new programs, services, initiatives, annual code updates, appeal letters and payer audits, including Medicare and Medicaid. Maintains department coding websites by updating coding guidelines, job aids, resource links and other coding references.
- Provides specialty-focused summary of coding resources. Communicates information through coding guideline revisions, coding meeting agendas, coding edit suggestions and website updates.
- Monitors various websites (including, but not limited to, Medicare, Medicaid, commercial payers, American Medical Association) and listservs for coding-related updates and communicates through coding guideline revisions, weekly/monthly notifications, coding edit suggestions and website updates. Collaborates with HB coding team regarding findings.
- Serves as a resource to all Hospital and Professional Coding team members as well as clinic leadership, clinicians, advanced practice providers, Physician Compensation, Clinical Informatics and Compliance. Maintains current knowledge of coding regulations for all specialties using informational sources.
- Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally (i.e. NCD, LCD) accepted coding policies and standards. Develops expertise in coding for assigned specialties. Communicates and reinforces changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinates necessary modifications and updates appropriately.
- Collaborates with HB coding quality team on necessary modifications and updates appropriately.
Licensure, Registration, and/or Certification Required:
- Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or
- Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
- Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
- Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
- Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
- Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
- Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), or
- Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).
Education Required:
- Associate's Degree (or equivalent knowledge) in Health Information Management or related field.
Experience Required:
- Typically requires 4 years of experience in acute care progressive hospital environment and professional coding that includes experiences in physician revenue cycle processes, health information workflows and/or compliance for a large complex health care system.
Knowledge, Skills & Abilities Required:
- Comprehensive knowledge of physician and home health coding guidelines.
- Extensive knowledge of third party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-9/ ICD-10, CPT/HCPCS coding classification systems.
- Comprehensive knowledge of medical terminology, anatomy and physiology.
- Comprehensive knowledge of Microsoft Office Suite (Word, Excel, PowerPoint) or similar products.
- Extensive knowledge of care delivery documentation systems and related medical record documents, electronic coding systems or applications.
- Comprehensive organization, prioritization, problem solving and reading comprehension skills.
- Comprehensive analytical ability, interpersonal communication skills and proven presentation skills.
- Demonstrates a high level of professionalism. Ability to deal and work effectively with multiple departments and in matrix organizational structures.
- Ability to work independently and exercise independent judgment and decision making.
- Ability to meet deadlines while working in a fast-paced environment.
- Demonstrated ability to work well with other professionals in a direct and positive manner.
Physical Requirements and Working Conditions:
- Exposed to normal office environment.
- Position requires travel which will result in exposure to road and weather hazards.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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