Professional Coder IV, PB Coding

40 hours per week, day shift

JOB SUMMARY: This position is responsible for lead coder tasks, including but not limited to assisting the coding manager with productivity and quality reporting, special projects, coder work allocation, new employee training and quality audits, and researching and responding to questions and concerns from coding employees. Responsible for assignment and review of ICD, CPT and HCPCS codes in the WakeOne health information system. Ensures that professional services are substantiated by codes and provider documentation. Responsible for auditing ICD, CPT and HCPCS codes and identifying and/or assisting in resolution of inconsistencies or data quality issues. Audit and problem-solving activities may require frequent and close collaboration with multiple areas of the organization including providers, facility coding, internal and external auditors and Finance.

EDUCATION/EXPERIENCE: Graduation from an accredited medical coding program and three years' experience in a professional coding setting; or an equivalent combination of education and experience. One year multiple specialty and/or patient type coding experience preferred. Epic Super User training preferred and required within 12 months of hire. General knowledge of anatomy and physiology and medical terminology required with completion of college level courses preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: Medical coding certification is required through AAPC, AHIMA or other professional coding societies. Specialty coding credentials preferred.

ESSENTIAL FUNCTIONS:

1. Works collaboratively with coding manager in process management/improvement.

2. Assists coding manager with team productivity and quality audit reporting.

3. Researches and responds to questions from team coders.

4. Codes records maintaining established departmental accuracy and productivity standards.

5. Identifies, assigns and appropriately sequences accurate diagnoses, procedural, and E/M codes. Applies correct ICD, CPT and HCPCS guidelines and regulatory requirements as per departmental policy regarding compliant methods, timeframes, productivity and quality standards, and use of applications.

6. Assists in demonstrating medical necessity for procedures and services performed by ensuring that all documented disease processes are coded.

7. Abides by the AAPC Code of Ethics and/or the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

8. Reviews and/or edits ICD, CPT and HCPCS codes that substantiate providers professional services for inpatient or ambulatory health records including ambulatory, ancillary and OR surgery, emergent and urgent care, observation, and clinic records and other work as assigned, maintaining established departmental accuracy and productivity standards. Data reported is used to meet licensure requirements, statistical purposes, and for financial and billing purposes.

9. Reviews and/or edits professional services to reflect accurately provider documentation according to regulatory, payer, and professional guidelines.

10. Applies necessary coding guidelines to permit claims processing in charge review, coding denial and/or claim edit work queues.

11. Resolves moderately-significantly complex coding and billing issues, and resolves pending charges in the WakeOne coding work queues assigned.

12. Functions at an expert coder level and participates in auditing, training, and re-training of coders as directed.

13. Interfaces with other departments as needed and provides excellent customer service.

14. Participates in on site and/or external training workshops as opportunities arise.

15. Maintains credentials, if applicable, and submits written evidence of maintenance.

16. Performs other related duties as requested by Manager.

SKILLS/QUALIFICATIONS:

• Demonstrates competency of knowledge base.
• Excellent problem-solving and critical thinking skills
• Ability to concentrate for extended periods
• Effective oral and written communication skills
• Strong customer service skills
• Demonstrates ability to work and contribute as part of an interactive problem solving team
• Ability to work effectively, independently, and manage multiple demands consistently
• Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process
• Skill in ICD, CPT and HCPCS coding classification systems, E/M levels, diagnosis and procedure selection, and sequencing guidelines
• Demonstrates competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations
• Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability
• Ability to operate multiple Windows based software applications
• Demonstrates full understanding and is competent and compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission.
• Demonstrates continuous learning as evidenced by personally developed reference materials, online publications etc., to stay abreast of new and revised guidelines, practices and terminology, for reference and application.

WORK ENVIRONMENT:

Moderate noise environment

Clean, comfortable environment

PHYSICAL REQUIREMENTS:

Amount of time spent performing the following activities:

0% 35% 65%

to to to

35% 65% 100% N/A Activity

X Standing

X Walking

X Sitting

X Bending

X Reaching with arms

X Finger and hand dexterity

X Talking

X Hearing

X Seeing

X Lifting, carrying, pushing and or pulling:

X 20 lbs. maximum

X 50 lbs. maximum

X 100 lbs. maximum