About the Job
Reviews, analyzes and resolves accounts that have failed coding and charging related claim edits, including departments requiring clinical/coding expertise. Responsible for validation of items, assuring the appropriate assignment of coding system, modifier(s) and revenue codes, by reviewing medical record documentation, facility protocol, regulatory guidance and other applicable documentation.
- Adheres to regulations and maintains a reasonable understanding of the billing process to ensure that hospital procedures and services are properly ordered.
- Coordinates with ancillary departments regarding the instruction of appropriate charge capture and regulatory guidelines.
- Identifies front-end process improvement initiatives; monitors coding changes for governmental agencies and other payers; educates departments on coding and compliance issues.
- Ensures revenue codes are in compliance with the Federal Register and other regulatory agencies. Uses various coding resources, including researching availability of additional documentation to assign accurate codes.
- Keeps abreast of federal regulatory agencies and changes in coding and reimbursement.
- Involved in coding system conversion projects in which new facilities are added to coding system structure.
- Serves as the coding resource with charge capture knowledge during coding system departmental reviews with responsibilities including voluminous charge validation and corporate mapping of each charge by department.
- Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action.
- Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.
- Bachelor's Degree required, or equivalent combination of education and related experience.
- Current Professional Coder Certification, or Current Coding Professional Certification required, plus specialized certifications as needed.
- 1-3 years of relevant experience, required.