Professional Services Coder

Position Purpose

To be responsible for accurately assigning diagnostic and procedural coding for all encounters associated with Renown Health Network and Ambulatory Services. This will also include translating patient information into alpha‑numeric medical codes using patient treatment, health history, diagnosis, and related information. Assignment of ICD‑10‑CM and CPT codes must be consistent with CMS' Official Guidelines and any regulatory agency guidelines.

Incumbents must be proficient with CPT and ICD‑10‑CM coding systems and be responsible for assigning ICD‑10‑CM diagnoses codes and CPT procedure codes accurately and completely to ensure optimal reimbursement and coding quality. Coders in this position are held accountable for adhering to coding guidelines; accounts must be coded within the quality and productivity standards specified by department leadership.

Incumbent is responsible for abstracting, analyzing, and assigning ICD‑10‑CM, CPT, HCPCS codes and appropriate modifiers for evaluation and management (E/M), minor procedures, and diagnostic tests by using either computerized or manual systems. Researches and resolves coding and reimbursement issues to ensure the accuracy, quality, and integrity of coding practices. Other responsibilities include:

• Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD‑10 codes, CPT codes, HCPCS codes, and modifiers.
• Reviews physician‑assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.
• Able to accurately abstract information from the medical records into the abstract system, according to established guidelines.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) and adheres to official coding guidelines.
• Enters and validates codes, charges and other edits flagged in EPIC for review.
• Reviews documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (e.g., NDC #, or number of units).
• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD's/NCD's for medical necessity.
• Communicates with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.
• Meets and/or exceeds the established coding productivity standards.
• Effectively communicates with clinicians and billing/coding teams regarding code changes and denials.
• Codes/Audits encounters within the Professional Services Coding Epic queues.
• Completes accountable work related to daily unbilled charges to ensure timely billing in conjunction with billing and compliance guidelines.
• Addresses appeals and reviews documentation needed for insurance denials to facilitate expedient resolution and reimbursement.

KNOWLEDGE, SKILLS & ABILITIES

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an…