Surgical Coder

Responsibilities

• Reviews all procedure and diagnosis codes submitted by provider for accuracy and maximum reimbursement against the documentation and according to AMA, ICD-10, NCCI and AAOS coding guidelines.
• Determines code selection according to AMA, ICD-10, NCCI and AAOS coding guidelines when providers do not submit suggested CPT and/or ICD-10 codes.
• Utilizes the AAPC Codify tool to determine bundling guidelines and assistant payable status in addition to NCCI edit tools as established in EPIC/current PM system.
• Communicates code changes to physicians via send back in basket message in EPIC/current PM system.
• Provides physicians with specific examples and appropriate references to support recommended coding changes.
• Verifies all codes against coding edits in EPIC/current PM system including NCCI bundling edits, payor specific requirement edits, modifier usage edits and any edit that is showing as needing review via an Error or Warning in the charge review data.
• Ensures all charges are posted and linked to the correct insurance set in EPIC/current PM system.
• Completes surgical and outside encounters that are ready to code or noted to have the appropriate operative report available with the established TAT of three business days.
• Runs the scheduled surgery report in the PM system daily to capture and review all scheduled surgical cases for assigned providers.
• Runs the outside encounter report in the PM system daily to capture and review all unscheduled visits to include hospital consultations, subsequent hospital visits, and unscheduled surgical cases for assigned providers.
• Updates reports when applicable and escalates any reporting issues to their management team.
• Maintains current workflow and investigates problem accounts. Informs management when information is consistently missing or otherwise unavailable.
• Reviews documentation including proper provider signatures, proper locations, proper date of service, proper provider and/or assistants and bills accordingly.
• Coder reviews procedure authorization for accuracy. If a CPT code that is billable but not found on authorization, a send back to site is required for them to obtain a retro authorization. Claim is still to be released and not wait for retro to be obtained, however.
• Coder is responsible for reaching out to provider and/or provider site contact to communicate any missing documentation that is not compliant. Claim is not to be billed until documentation is found to be corrected by provider and/or site and found to be compliant.
• Coder prepares and submits additional documentation for billing of unlisted codes including verifying comparable code and placing appropriate detail in Box 19 of HCFA for reference of payor.
• Aids coding department, RCM and/or IBJI site staff with any coding questions.
• Maintains productivity on a daily basis by monitoring end user productivity report in PM system. Any work and/or time spent outside of the EPIC/current PM system is to be reported on the coder's time management spreadsheet to ensure time punched in according to TimePro is accurate.
• Works surgical/outside encounter denials as assigned on the weekly denial schedule.
• Attends scheduled meetings via Google meet or in person when required. This may require the camera to be on at times.
• Responds to emails and Google chats within a timely manner.

Qualifications

• High school diploma or GED.
• Must have Physician Coding Credentials from AAPC or AHIMA.
• Three years minimum experience in coding for orthopedic surgery subspecialties preferred.
• Knowledge of coding guidelines following AMA, ICD-10, NCCI and AAOS.
• Ability to exercise independent judgment and react appropriately in stressful situations.
• Skill in defining problems, collecting data and interpreting medical billing information.
• Skilled in computer applications, email, zoom meetings, etc.
• Excellent communication skills and analytical skills.