PB -Coder III - Neuro Surgery

About the role

The Coder is responsible for reviewing outpatient clinical documentation via Epic and 3M CAC for assignment of ICD-10-CM diagnoses and CPT-4/HCPCS procedure coding systems. Through knowledge of coding conventions and guidelines.

Responsibilities

• Reviews outpatient clinical documentation via Epic and 3M CAC for assignment of ICD-10-CM diagnoses and CPT-4/HCPCS procedure coding systems.
• Addresses commonly applied modifiers for hospital outpatient accounts.
• Extracts pertinent information from clinical notes, operative notes, radiology reports, laboratory reports, (including Pathology), procedure records, specialty forms, etc.
• Determines complex code assignment pertinent to emergency visits and diagnostic workups.
• Codes complex surgical, special procedures, observation records, inpatient records, medical, diagnostic, procedural, and/or recurring records within.
• Evaluates medical record documentation, paper charge, discharge disposition, ICD-10 and CPT coding to optimize reimbursement by ensuring that medical, diagnostic and procedural codes and other documentation accurately reflect and support the visit.
• Compiles necessary documentation prior to coding review; when documentation is not available, performs the appropriate steps to obtain the necessary documentation per the department’s policies and procedures.
• Works independently to resolve issues, applying root cause analyses to determine steps required for timely resolution.
• Mets established productivity and accuracy standards.
• Demonstrate the ability to communicate effectively and professionally in interactions with physicians, management, and staff.
• Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes; offers physician opportunity to submit corrected documentation.
• Notifies appropriate individuals of potential non-compliance with Medical Necessity requirements and when services are non-covered or not payable, as appropriate.
• Corrects failed claim errors to billing edits, coding denials, quality management data edits and/or other errors identified through various auditing or billing process.

Qualifications

• Four (4) years of coding experience required, two (2) years of experience must be in a Surgical/Ancillary Diagnostic discipline or 1 year of experience with specialty coding certification in a Surgical/Ancillary Diagnostic discipline.
• Knowledge of CPT and ICD-10 coding conventions.

Skills

• Strong surgical specialty background in Neurosurgery, Trauma, Ortho, Plastic Surgery, etc.
• Ability to research the root causes related to the inability to code and drop accounts.

Benefits

Grady’s Total Rewards package includes:

• Health & Wellness: Medical, dental, vision, and prescription drug coverage.
• Financial Security: Retirement savings plans with employer contributions, life insurance, and disability coverage.
• Work-Life Balance: Paid time off, holidays, and family leave benefits.
• Career Growth: Tuition reimbursement, professional development programs, and opportunities for advancement.
• Employee Support: Employee Assistance Program (EAP), wellness initiatives, and discounts on services.

Pay

Competitive pay based on experience and qualifications.

Schedule

Full-time position.