Abstractor​/Coder

Department

BSD UCP - Professional Billing Coding - Surgical Specialty

The Biological Sciences Division (BSD) and the University of Chicago Medical Center (UCMC) are managed by a single Dean/Executive Vice President and comprises the largest unit of the University, accounting for 60% of its annual budget. All physician, hospital, and clinic services are managed through the Medical Center, which is a $1.3 billion enterprise. The BSD includes the Pritzker School of Medicine, approximately 20 academic units, degree granting committees, and research centers and institutes.

The BSD is located on the University s main campus in Hyde Park, ten minutes south of downtown Chicago. BSD s patient care operations are conducted primarily at the University of Chicago Hospital and clinics, which share the same campus. The University of Chicago Practice Plan (UCPP) is the central organization that supports the clinical activity of nearly 850 clinically active faculty practicing at the University of Chicago.

These clinically active faculty collectively form the University of Chicago Physicians Group (UCPG). The University of Chicago Physicians  Group (UCPG) is a component of the physician practice plan for the University of Chicago. The UCPG department provides billing services for medical services provided by University physicians and manages the accounts receivable collection and reporting processes for the Biological Sciences Division (BSD) departments.

Each physician is a faculty member and is based in a specified department in the BSD.

Job Summary: Under moderate supervision, the Abstractor/Coder is responsible for accurate and timely review and coding of inpatient and outpatient physician services including procedures and surgeries. Ensure that all external regulations affecting the coding process are administered to compliance. Review physician reports and append appropriate CPT, HCPCS, ICD-10 codes, and modifiers verifying that physician documentation supports the billing. Perform and facilitate accurate charge capture of physician services through the review of provider documentation to abstract and/or validate ICD and CPT codes.

Responsibilities:

• Obtain appropriate reimbursement levels for professional services by reviewing and coding physician services including but not limited to procedures, evaluation and management services, diagnoses, and modifiers.
• Analyze denial and rejection reports, and appeal wherever appropriate.
• Submit charges in a timely manner.
• Work in collaboration with the team to provide guidance to faculty and staff on the charge capture and documentation processes.
• Work in collaboration with clinical revenue management and others, provide guidance to faculty and staff on the charge capture and documentation processes.
• Educate physicians and support staff on coding issues, including issues related to fraud.
• Assign appropriate CPT, HCPCS and ICD-10 codes for professional services as per designated workflow.
• Review and resolve edits resulting from these services in a timely manner.
• Query physicians to clarify conflicting, imprecise, incomplete, ambiguous, and/or inconsistent documentation when appropriate.
• Ensure coding compliance to all relevant internal and external regulations.
• Other duties as assigned.

Competencies:

• High-level proficiency in medical terminology, anatomy and physiology, ICD-10, HCPCS and CPT coding classification systems as demonstrated by certification through a nationally accredited body (e.g., AAPC or AHIMA) required.
• Must demonstrate exceptional attention to detail with a commitment to accuracy in coding and billing processes.
• Understanding of CMS guidelines, familiarity with third-party payer rules and reimbursement policies.
• Proficiency in Microsoft Word, Excel and Adobe required.
• Communicate effectively in English, both orally and in writing.
• Manage interpersonal relationships and interact/communicate with clarity, tact and courtesy with patrons, patients, staff, faculty, students and others.
• Identify priorities; recognize and resolve or refer problems; work effectively with supervision and as a part of a team; use or learn a range of…