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Thisposition will be functioning under minimal supervision and utilizingindependent decision making. Thisposition is to problem solve and complete edits with consistency andefficiency. The Edit Coder will investigate and solve edit issues and communicateroot cause data to management to solve problems upstream and downstream.
Responsiblefor modifying and completing moderate to high complexity coding and chargingedits/errors using ICD-10-CM, CPT and HCPCS or any other designated codingclassification system in accordance with coding rules and regulations. Abidesby the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical informationfrom the medical record. Working in BillScrubber systems a requirement.ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned.
Performsdata quality reviews on outpatient encounters to validate the ICD-10-CM, CPT,and HCPCS Level II code and modifier assignments, APC group appropriateness,missed secondary diagnoses and/or procedures, and ensure compliance with allAPC mandates and outpatient reporting requirements. Monitors medical visit codeselection by departments against facility specific criteria forappropriateness. Assists in the development of such criteria as needed.Monitors facility CRC reports for prebill edits related to APC. Addresses CCI and LCD edits within thevarious billing scrubbers while abiding by the Standards of Ethical Coding asset forth by the American Health Information Management Association. Meetsand/or exceeds Conifer s APC specialist productivity standards.
Reviewsclaim denials in comparison with medical records for the determination ofaccurate assignment of all documented diagnoses and procedures adhering to thestandards of ethical coding.
ProfessionalDevelopment: Stays current with AHA Official Coding and Reporting Guidelines,CMS and other agency directives for ICD-10-CM/PCS, ICD-10 initiatives, andCPT/HCPCS coding. Stays current with CMS annually updated National CorrectCoding Initiative Coding Policy Manual, CMS coding and billing regulations, MUEand OCE.
Monitorsinpatient and outpatient unbilled accounts report for outstanding and/oruncoded outpatient encounters to reduce accounts receivable days foroutpatients. Brings identified issues to department managers forresolution.
Qualifications : KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individualmust be able to perform each essential duty satisfactorily. The requirementslisted below are representative of the knowledge, skill and/or abilityrequired. Reasonable accommodations may be made to enable individuals withdisabilities to perform the essential functions.
Advancedpersonal computing skills including MS Outlook, MS Word, MS Excel
Advancedtechnical skills required to learn and navigate a variety of software systems,trouble-shoot computer problems, install periodic updates to software programsand work efficiently in a virtual environment
Strongwritten and verbal communication skills
Abilityto think/work independently, yet interact positively with team
Advancedproblem-solving skills and ability to quickly analyze a situation.
Attentionto detail is crucial to this position.
Otherfunctions as deemed necessary to complete and final bill claims accurately
Include minimum education, technical training,and/or experience required to perform the job.
Outstandinginterpersonal communication skills as well as excellent oral and writtencommunication skills
Knowledgeof medical terminology, anatomy and physiology, disease process, and surgical procedures
RHIA,RHIT or CCS preferred but not required.
The physical demands described here arerepresentative of those that must be met by an employee to successfully performthe essential functions of this job. Reasonable accommodations may be made toenable individuals with disabilities to perform the essential functions.
Abilityto lift 15-20lbs
Abilityto sit and work at a computer for a prolonged period of time completingassessments and analysis
Includesability to walk through hospital-based departments across broad campussettings, including Emergency Department environments
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