at Edward-Elmhurst Health in Warrenville, Illinois, United States
Job Description
GENERAL SUMMARY:
This position has a deep understanding of disease process, A&P and pharmacology and acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient’s service. Assigns diagnostic and procedure codes for compliant physician reimbursement and for both evaluation/ management, preventive (HCC risk adjustment) and surgical services under general supervision. Communicates regularly with physicians and staff to resolve discrepancies with patient records and coding selections. Performs provider audits on E/M (evaluation/management) services and HCC review on Medicare/Medicare Advantage preventive services and educates providers as needed. Trains physicians and other staff regarding documentation, billing, and coding. CORPORATE PHILOSOPHY: It is the obligation of each employee of Edward – Elmhurst Health to abide by and promote the mission and values of the system to ensure that excellent services are delivered with compassion . PRINCIPAL DUTIES AND RESPONSIBILITIES: (The following duties and responsibilities are all essential job functions, as defined by the ADA, except those that begin with the word “May.”)+ Utilizes technical coding expertise to review the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis (including, operative and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and Management services, bedside procedures and diagnostic tests as needed.
+ Follows CMS and CPT Official Guidelines and rules to assign appropriate CPT, ICD10, HCPCS codes and modifiers with a minimum of 95% accuracy.
+ Queries provider when necessary to obtain information needed to code services. Notifies provider of any coding changes related to insufficient documentation and/or coding guidelines.
+ Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports)
+ Partners with EEH physician service denials staff and Office Supervisors to resolve coding related denials on daily basis to ensure appropriate and compliant reimbursement. Performs researches of CPT, CMS and commercial insurance policies to validate correct coding. Corrects any coding errors and resubmits charges. Communicates with denials staff frequently to resolve denial issues.
+ Communicates with providers regarding pertinent coding changes, individual coding behaviors daily. Works collaboratively with physicians regarding questions concerning documentation, diagnosis coding and level of service.
+ Responds to provider/site coding inquiries; reviews accounts and medical records to resolve issues and disputes.
+ Orients new providers and appropriate staff to coding procedures and guidelines. Creates coding resources and guides. Conducts physician and staff education (e.g. production reports, code utilization patterns,etc.
+ Reports any non-compliant activity to Corporate Compliance Officer. Assists in resolving compliance issues of non-compliant activity.
+ Research information and coding rules to assist others in making changes/improvements in coding/billing policies, procedures, and system templates.
+ Performs audits on EEMG Providers and perspective incoming providers utilizing MD Audit system in accordance with Corporate Compliance requirements. Communicates audit results to provider and appropriate management. Meets with provider for audit related coding education. Maintains reports of all audit activities, submitting same to Corporate Compliance sub-committee.
+ Maintains current information related to reimbursement and coding trends/issues through membership in professional organizations, attendance of conferences and workshops, relationship with payers, resource materials and publications to ensure current information is secured, maintained, and distributed to providers.
+ Performs other related duties as needed in order to support the achievement of department goals and objectives.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED: Required:+ Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS).
+ Zero (0) to two (2) years of experience in a relevant role.
+ 94% accuracy on organizations coding test.
Preferred:+ Bachelor’s or associate degree in a Health Information Management program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).
+ Previous experience with physician coding.
