PB HIM Coding Specialist

Overview

The Professional Fee Coding Specialist II rles Health System is responsible for coding and charging SCMG Clinical Services as well as resolving billing edits and denials. This position does not directly manage other caregivers, however, may be asked to review and provide feedback on the work of other caregivers.

• Read and interpret medical record documents to identify and code all relevant ICD-10-CM diagnoses and CPT-4 procedures for professional fee charges using an encoder program, following National and SCHS coding guidelines, Coding Clinic, CPT-4, and other coding references to ensure proper code assignment and modifiers.
• Abstract medical record information in compliance with CMS requirements and SCHS abstracting procedures as appropriate; use available tools to check entries for accuracy (including data for clinical studies and quality management activities).
• Capture correct modifiers appropriate for CPT code assignment.
• Reconcile CCI and Medical Necessity edits.
• Maintain productivity and quality standards.
• Collaborate with the Patient Financial Services department on medical necessity issues, claim denials, charge master issues, and charge auditor issues.
• Support the vision, mission, and values of the organization and promote Lean continuous improvement.
• Provide a safe environment for caregivers, patients, and guests; conduct activities with professionalism and confidentiality; comply with laws, policies, and procedures; support corporate integrity; report known or suspected violations.
• Deliver customer service and/or patient care that is timely, efficient, and accurate.
• May perform additional duties of similar complexity within the organization as required or assigned.

• Required
  :
  High School diploma or GED; graduate of an AHIMA Accredited Health Information Technology program or certification in a self-study course from AHIMA or AAPC.
• Preferred
  : N/A

• Required
  :
  Must possess a valid Registered Health Information Technician (RHIT) certification or one or more of the following: RHIA, CCA, CCS, CCS-P, CPC, COC, CPC-H. Maintain required educational credits (CE) through AHIMA or AAPC.
• Preferred
  :
  Risk Adjustment Coding (micro credential) or AAPC’s Certified Adjustment Coder (CRC). Maintain required education credits (CE) through AHIMA and/or AAPC.

• Required
  :
  Minimum of one year of hospital or professional coding experience with a Health Information Management focus.
• Preferred
  :
  Familiarity with 3M encoder.