Professional Services Coder III
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Decatur, IL 62521
Professional Services Coder III
Clerical, Administrative and Business Support
Decatur Medical Group (“DMG”) consists of physician and non-physician practitioners providing professional services to Decatur Memorial Hospital patients. The Professional Services Coder III (“PS Coder III”) provides documentation review, coding and billing services to in accordance with DMG’s compliance plan, following its policies and procedures, official and regulatory coding guidance. Understanding and accurate use of approved coding guidelines is paramount to successful performance in this position.
Education and/or Other Requirements
Minimum High School Diploma or equivalency. College degree and / or extended education in an allied health field preferred.
- Possess an established coding credential from AAPC (CPC) or AHIMA (CCS-P) pertaining to professional fee coding and remain in good ethical standing, by obtaining the necessary continuing educational certification requirements.
- Five (5) or more years’ experience in healthcare billing, coding, edit and denial activities for professional coding services.
- Knowledge of ICD-10-CM and CPT/HCPCS coding systems.
- Knowledge of medical terminology, pharmacology, pathophysiology and Anatomy and Physiology.
- Understanding of medical records content, format and other pertinent procedures.
- Knowledge of pertinent reimbursement systems, including but not limited to Medicare and Medicaid Physician Fee Schedule and RBRVU system.
- Knowledge of EMR systems and the ability to learn the DMH / DMG EMR system(s) efficiently.
- Knowledge of encoder software tools for professional services.
- Knowledge of CMS Guidelines including but not limited to NCCI policy manuals, LCD/NCD policies etc.
- Possess basic PC skills, including ability to work with MS Word, Excel and Outlook.
- Thoroughness and attention to detail.
The PS Coder III is responsible for reviewing the medical record to independently determine the appropriate CPT / HCPCS procedure codes, modifiers, and ICD-10-CM (diagnosis) codes are supported by medical record documentation for submission to commercial and government payors. The Coder is also responsible for working through to resolution claim edits and coding denial work queues and billing follow up and denial management requests when needed.
- Identifies and assigns appropriate codes for the purpose of reimbursement, research, and compliance in accordance with ICD-10 and CPT coding guidelines.
- Reviews all professional services encounters and assigns and sequences all diagnoses and procedure codes to the highest level of specificity documented in the provider notes.
- Accurately assign Evaluation & Management (“E/M”) services after review of the provider’s documentation in accordance with the 1995 or 1997 E/M documentation guidelines.
- Assign ICD-10-CM, CPT / HCPCS coding and modifiers for professional services.
- Complies with all federal, local and other legal requirements as they relate to medical coding practices.
- Observes confidentiality and safeguards all patient related information.
- Follow CMS Guidance including but not limited to NCCI policy manuals, LCD / NCD policies etc.
- Understand and follow DMG specific coding requirements.
- Complete coding tasks while maintaining the required accuracy and productivity standards.
- Utilize DMG’s Epic electronic health record (“EHR”) and other DMG and DMH documentation and billing systems to abstract and code all professional services, including data entry of codes.
- Works claim edit and denials queues for HIM Provider Based Billing.
- May assist in training new coders or quality functions as required.
- Use professional services encoder software to determine RVU values for correct coding assignment and modifier use.
- Must be able to perform quality reviews, provide reports and assist with developmental education material.
- Participate in DMG’s coding quality reviews as deemed appropriate by the HIM Director.
- Attend continuing education classes to maintain coding credential and continually improve proficiency in areas of coding that include but are not limited to CPT, ambulatory surgery, surgical specialties, E/M assignment, ICD-10-CM and other specialties as required.
- Interpret coding rules and general policies in addition to determining appropriate conclusions.
- Review, research and resolve claim edits and coding denials based on assigned specialties.
- Complete administrative activities such as time reporting, productivity reporting and expense reporting as necessary and in accordance with established policies and deadlines.
- Communicates in a positive and professional manner with visitors, physicians, and hospital staff.
- Perform other job-related duties as required.
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Memorial Medical Center is an equal opportunity employer and will not discriminate against any employee or applicant on the basis of age, color, disability, gender, national origin, race, religion, sexual orientation, veteran status, or any classification protected by federal, state, or local law.