PROFESSIONAL CODER

The Professional Coder provides timely and accurate clinical and administration data to ensure optimal reimbursement for professional services performed at acute care, inpatient, outpatient, urgent care or physician offices to meet organizational needs. This position is responsible for ICD10CM diagnosis, CPT-4 coding and charge entry related to coding, documentation, billing and reimbursement issues. Works as a liaison between centralized billing staff, practice managers and office staff and may be required to meet with the office staff and physicians as needed. This position is responsible for the monitoring the quality of coding and stays current on professional coding changes, compliance issues, billing, documentation, reimbursement and interpretation of coding/documentation rules. Primary patient contact is only social.

He/she d emonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

Contributes to organizational success targets for patient satisfaction.

F ormulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients and other staff members of departments encountered.

A dhere to coding rules for coding professional services for multiple specialties (such as; neurosurgery, pediatric surgery, rehab, orthopedic, cardiology, etc.), urgent care, occupational health, family practice and other to ensure quality coding based upon documentation within the patient record.

F ollows policies, procedures and guidelines to assure consistent coding quality. At the same time utilizes analytical skills when reviewing charts, interpreting documentation and applying codes, sufficing edits, etc.

A ssures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur.

P articipates in HIM department meetings and area specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required.

A ssist in achieving departmental, AR and area specific goals.

C harge entry for professional services (office and/or hospital based for acute care, urgent care, specialty care, occupational health, skilled nursing, et. Services).

S upports physicians, leadership, managers and staff on coding and documentation related items. Problem solves, researches topics, make recommendations and provides education as needed.

A bility to develop training or educations materials.

P erforms E & M, procedural or other specified coding audits for many professional settings and services.

H elps to identify solutions to problems and assists in resolving issues related to coding.

S hares knowledge during training of new staff and is a resource to others.

I ndependent learning with desire for continued personal and professional growth. Stays current on coding updates and publications.

U tilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.

M aintains professional credentials.

R equired to provide written and oral feedback to providers on audits, for education, or other as required.

M ust be professional, self-motivated, and work independently with the ability to make sound decisions, analyze issues and solve problems.

A ssist CBO/Finance/Data/CMG/ Other as requested for follow up on items related to coding, billing or reimbursement.

A ssure that all legal requirements, including Federal (HIPAA) and State regulations are met.

D emonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and Department Policies and Procedures.

Participates in development and attainment of department and workgroup goals.

Perform other duties as assigned which may include: working with students, develop policies, guidelines or other documents in order to facility complete and timely gathering of information for clinical, billing or coding.

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EDUCATION/EXPERIENCE

C ertified Professional Coder (CPC) required or Associates Degree/Certification in medical curriculum with two years coding experience in a professional setting. May substitute two years ICD9/10CM and CPT-4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 12 months of the start date.

E xperience in professional coding setting/physician office setting preferred.

C oding experiences preferred utilizing ICD9/10CM and CPT-4 coding books and references in a professional setting.

M ust be able to tolerate working under stress, limited time constraints and with frequent interruptions and deadlines.

P refers 2 years’ experience in interpreting professional/physician remittance advice statements for all major insurance payers for multiple physician specialties.

KNOWLEDGE/SKILLS/ABILITIES

Basic computer skills including the ability to search for work related items on line using the internet.

Knowledge of standard office equipment.

Knowledge of computer use including EMR, email/Lotus Notes/Outlook, internet, and other software as needed (Word, Excel, Intelicode, Systoc, AAPC, etc.).

Knowledge/understanding of medical terminology and anatomy.

Knowledge of third party payer coding and billing reimbursement.

Knowledge of ICD9/10CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines.

D emonstrates effective communication methods and skills, both verbally and in writing.

U ses appropriate organization/priority setting skills to complete work timely and accurately.

Practices effective problem identification and resolution skills as a method of sound decision making.

Demonstrates interpersonal skills required to work with many other people and personalities.

Requires the ability to use sound judgement, based upon the latest guidelines, federal and state statutes and regulations, as well as hospital and departmental policies.

Continued growth in many areas.

Ability to sit and look at computer screen for long periods of time.

Ability to be flexible to adjust assignments as priorities change.

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.

Constant sitting, use of hands to finger, handle and feel.

Constant hearing and near vision.

Frequent depth perception, midrange and far vision.

Frequent color and field of vision.

Frequent lifting 0-10 lbs.

Occasional lifting 11-50 lbs.

Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.

Occasional twisting, reaching and talking. ICIMCHNonNJ