Professional Coder

Summary

The Coding Specialist reports to the Manager of Physician Coding. Ensures that appropriate diagnostic and procedural codes (CPT-4, ICD-9/10, HCPCS) are submitted for professional charges resulting in accurate claims processing, data retrieval, and analysis. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences Patient and Community Focus and Collaborate.

• Assesses adequacy of the documentation for the provider visit or procedure that supports the diagnosis.
• Reviews procedure codes selected by the provider for hospital services and complex office services; evaluates all diagnoses for medical necessity and adequate specificity.
• Queries providers when documentation in the patient record is inadequate, unclear, does not support the assigned code, or indicates that additional services were performed that were not coded.
• With provider consent, corrects and revises codes to ensure compliance with federal law, payer guidelines, and requirements, and to ensure optimal reimbursement.
• Refs coding, billing, and system questions to the Manager after exhausting own efforts and referencing appropriate coding publications and other resources.
• Performs audits of provider coding and documentation as required, and educates providers regarding improvement.
• Remains current with coding guidelines and documentation requirements.
• Maintains coding certification by earning required continuing education units.
• Performs other related duties, as assigned.

Basic Knowledge:
High school diploma or equivalent; successful completion of formal education in medical coding; certification from the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other association required.

Experience:

One year medical billing experience in a hospital, medical office, or billing company, or equivalent; coding experience preferred; training in anatomy, physiology, and disease processes preferred; ability to analyze patient records and recognize clinical documentation pertinent for coding; writing skills sufficient to prepare physician queries; computer skills to research internet websites and access payer policies; proficiency with Excel, Word, Adobe Reader, Microsoft Outlook, and third‑party payer websites;

previous Epic experience a plus.

$22.04–$36.37

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

8:00-4:30

Day

8 hours

No