Professional Coder-Certified

PURPOSE:

Reporting to the Billing Team Supervisor, the professional coder is responsible for reviewing clinical documentation to abstract and/or validate CPT and ICD-10 coding for office based and outpatient professional services.

ACCOUNTABILITIES AND JOB ACTIVITIES:

• Ensure that medical coders are trained, knowledgeable and consistently adhering to key responsibilities relevant to job description

• Train new employees

• Perform ongoing training and education as needed

• Conduct audits to ensure the accuracy of the coding team and re-train and/or initiate coaching if necessary

• Monitor daily workload to ensure that claims are created in a timely manner 

• Ensure that professional and facility service claims are created on a daily basis without interruption

• Responsible for alerting proper parties if any interruptions are discovered

• Analyze office progress notes, procedural and operative records to identify and independently assign accurate ICD and CPT/HCPCS codes while adhering to ICD-10-CM, CPT and all appropriate government coding guidelines, in addition to adhering to all CPC/IPM coding/billing policies and procedures

• Resolve coding related edits in the AthenaOne practice management system by applying the aforementioned rules, policies and procedures

• Abstract pertinent information into the billing system accurately and timely

• Maintain compliance with Federal, State and Payer regulations

• Serve as a subject matter expert to the coding team and clinicians as needed

• Keep abreast of current coding changes, documentation requirements and payer policies within designated specialties

• Demonstrate the ability to educate/train coding staff, physicians and mid-level providers as needed

• Assist with coding denials received from payers

• Identify denial trends and educate the coding team and/or request system edits as needed

• Appeal claims as needed and assist with the development of letters of medical necessity as required

• Assist with charge capture initiatives by monitoring services performed to assure all encounters are captured, coded and billed within timeframes established by CPC/IPM

• Monitor all AthenaOne claim worklists to ensure that charges are being worked in a timely fashion and alert management team as needed if any concerns are identified

• Attend meetings and training sessions virtually or by traveling to provider and business locations as needed

Develop and maintain personal and professional skills

• Attend all mandatory staff meetings per year unless excused as evidenced by documentation

• Attend mandatory in-services and a minimum of two pertinent in-services per year as documented

• Actively participate in performance improvement activities as observed or documented

• Establish realistic professional goals as evidenced by the annual performance evaluation

• Actively keep abreast of departmental and organizational activities

• Demonstrate flexibility in response to unexpected change in workload or situations as observed

• Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle

• Assist in the orientation of new personnel as directed

• Support the mission and goals of the company as observed

• Address all emails within 24 hours as documented

• Perform other duties as required

Demonstrate safe and cost-effective practice

• Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed

• Consistently utilize proper body mechanics as observed

• Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart

• Consistently allocate resources to reduce waste and minimize costs as observed

• Consistently complete assigned duties within stated shifts in a timely manner as observed and documented

• BEHAVIORAL EXPECTATIONS

  Strive for excellence

• Set challenging goals

• Produce quality work in a timely fashion

• Maintain current knowledge and skill

• Participate in quality and process improvement efforts

• Keep the work area clean, safe and secure

Act Flexibly

• Adapt to change

• See the value of different opinions and new ideas

• Change plans and objectives given new direction or priorities

• Handle stressful situations effectively

Meet Customer Needs

• Meet internal and external customers’ needs

• Find new ways of satisfying customers

• Participate in service improvements efforts

• Listen and respond to customers

• Treat customers with compassion and respect

Work as a Team

• Work as a team player

• Pitch in to help those in need

• Communicate with others appropriately

• Listen and respond to others

• Handle conflict situations effectively

• Foster trust and respect within the team

• Participate in committees and task forces

• Foster Diversity in the Workforce

• Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability

• Treat all associates and customers fairly

Be Self-directed

• Take initiative and responsibility for actions

• Identify own learning needs and create/implement Learning Plans

• Perform duties according to policies and procedures

• Demonstrate ethical behaviors

• Maintain confidentiality of information

• Maintain licenses and certifications as appropriate

• Fulfill operating unit/clinical competencies

• Use equipment/resources responsibly

• You must refer to upper management for approval or final disposition on the following

• Change in procedure

• Difficult patient situations

• Any situation you are unsure of

JOB REQUIREMENTS