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Remote Physician Pro Fee Coding Specialist-Hospital Medicine ID-20090

Job Summary

The Coder Physician provides quality review and analysis of a wide range of patient medical records and ensures accuracy of coding. This role ensures appropriate assignment of diagnostic and procedure codes for services and treatments as documented in the medical record. This includes sequencing appropriately as per government and insurance guidelines, adding the appropriate modifiers and ensuring appropriate place of service codes are utilized.

Essential Functions

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  • Ensures appropriate coding by reviewing the diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, material, injections and drugs with International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Health Care Financing Administration Common Procedure Coding Systems (HCPCS - all levels and any other coding classification systems that may be required). Maintains a working knowledge of CPT, HCPCS and ICD coding principals, governmental regulations, protocols and third party requirements regarding billing and documentation.
  • Reviews documentation in the legal medical record to ensure that all professional fee services documented are coded with the appropriate CPT, HCPCS and ICD codes. Requests additional information as needed to clarify missing or inadequate medical record information required to complete the coding assessment and adhere to documentation and billing requirements. Makes corrections as needed to ensure accurate coding, billing and reimbursement processing.
  • Performs edit checks on data entered prior to transmittal and corrects errors as indicated. Works any coding related holds/scrubs identified through the Athena Collector system to ensure proper coding. Ensures assigned projects are completed in a timely manner.
  • Maintains strict confidentiality of provider information, patient data, financial and billing information. Complies with all policies and procedures of the Corporate Compliance Program. Reports Noncompliance issues detected to the department Manager, Director and/or the Senior Director of Physician Coding and Documentation.
  • Reports coding related issues and/or opportunities to the education team to allow that team to work with the clinicians for optimal documentation practices. Works with other staff members to inspire teamwork and promote cooperation.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Qualifications

  • H.S. Diploma or GED required
  • Associate Degree in Health Information Management or related field preferred or
  • 1 year coding certification in Health Information Management or related field preferred
  • 4-6 years experience working with physician offices or clinics working with diagnostic and procedure coding and/or medical billing required

Knowledge, Skills and Abilities

  • Possess a vast knowledge of CPT, ICD and HCPCS coding and reimbursement issues for physician offices and clinics.
  • Strong knowledge of 1995 and 1997 Documentation guidelines.
  • Excellent understanding and comprehension of medical terminology.
  • Must have the ability to balance and juggle multiple tasks, projects and requests.
  • Must be able to make sound decisions objectively and follow through.
  • Ability to communicate effectively any issues or weaknesses with coding and documentation to the providers.
  • Must be detail oriented and analytical.
  • Able to interact confidently with providers, staff, corporate CHS management and/or other CHS affiliated personnel.
  • Possess clinical knowledge and ability to evaluate and summarize clinical records to support successful appeal.
  • Ability to define problems, collect data, establish facts, and draw valid conclusions.
  • Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  • To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software; practice management software and electronic medical records software.

Licenses and Certifications

  • Certified Pension Consultant (CPC) required or
  • CCS-Certified Coding Specialist CCS-P required or
  • RHIT - Registered Health Information Technician required
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