Duties:
Role Hard requirements:
• Must reside in California (role will transition to FTE)
• Minimum 3 years of experience as a physician/professional fee coder
• Strong expertise in diagnostic radiology coding and bundling rules
• Radiology experience required
• Knowledge of charge submission within EPIC
• ProFee coding only – No HCC coders
Position Summary:
• Under the direction of the Coding Compliance Manager, the OP Ancillary/Physician Coder will play a key role in reviewing and analyzing billing and coding for charge processing.
• This role will be responsible for reviewing and accurately coding office, hospital, and surgical procedures for reimbursement, as well as ensuring accurate and compliant medical coding for both inpatient and outpatient services, diagnostic tests, and other medical services rendered to each patient.
Essential Duties:
• Possess analytical skills.
• Solid understanding of the health care revenue cycle.
• The ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams.
• Collaborative team player with the ability to adapt to the everchanging healthcare environment.
• Achievement of productivity standards as established by management.
• Achievement of quality standards as established by management.
• Analyze and interpret medical information in the medical record and assign and sequence the correct ICD10CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines.
• Follow established workflow for working claim denials in the FollowUp work queues and identify opportunities for billing/coding improvements.
• Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
• Optimization opportunities include, but are not limited to, work in the FollowUp and Claim Edit work queues and analyzing denial trends.
• Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams, and work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues.
• Perform monthly coding change report analysis/oversight on provider coding change trends and communicate/educate providers, as needed.
• Work weekly Missing Charge Reports to identify missed billable charges to maximize reimbursement.
Skills:
Required Skills & Experience:
• Three (3) years’ experience working in a hospital or physician’s office as a medical coder and interacting with physician.
• Expert knowledge of ICD10, CPT and HCPCS.
• Strong knowledge of medical terminology, anatomy and physiology.
• Proficient Microsoft skills.
Preferred Skills & Experience:
• Epic software experience.
Education:
Required Education:
• High school diploma or GED.
Preferred Education:
• Associate's degree.
Required Certifications & Licensure:
• CPC, CCS or equivalent certification offered by the AAPC and AHIMA.