Professional Services Coder

Responsibilities

• Abstracts, analyzes, and assigns ICD-10-CM, CPT, HCPCS codes and appropriate modifiers for evaluation and management (E/M), minor procedures, and diagnostic tests.
• Researches and resolves coding and reimbursement issues to ensure accuracy, quality, and integrity of coding practices.
• Absolutely codes diagnoses, treatments, and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity.
• Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.
• Able to accurately abstract information from the medial records into the abstract system, according to established guidelines.
• Able to abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).
• Enters and validates codes, charges and other edits flagged in EPIC for review.
• Reviews documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units).
• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity.
• Communicates with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.
• Maintains and meets established coding productivity standards.
• Effectively communicates with clinicians and billing/coding teams regarding code changes and denials.
• Codes/Audit encounters within the Professional Services Coding Epic queues.
• Completes accountable work related to daily unbilled charges to ensure timely billing in conjunction with billing and compliance guidelines.
• Addresses appeals and reviews documentation needed for insurance denials to facilitate expedient resolution and reimbursement.

Qualifications

• Knowledge of Anatomy and Physiology, Pharmacology, Disease Pathology, and Medical Terminology.
• Knowledge of modifiers, ICD-10-CM, CPT (including E/M) and HCPCS coding.
• Knowledge of Evaluation and Management Guidelines and auditing to assist in provider education and identifying possible revenue opportunities.
• Conversion of written description to proper billing codes.
• Ability to appeal CPT and ICD-10-CM for maximum reimbursement.
• Utilize critical thinking and problem-solving abilities.
• Comprehension of disease processes.
• Able to work well with others.
• Able to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges.
• Uphold a strong work ethic characterized by honesty and dependability.
• Demonstrate personal time management skills, including organization, prioritization, and multitasking.
• Adherence to company policies, procedures, and directives.