Professional Coder

Overview

The Professional Coder provides timely and accurate clinical and administrative data to ensure optimal reimbursement for professional services performed at acute care, inpatient, outpatient, urgent care, or physician offices to meet organizational needs. This position is responsible for ICD
10CM
diagnosis, CPT‑4 coding, and charge entry related to coding, documentation, billing, and reimbursement issues. Works as a liaison between centralized billing staff, practice managers, and office staff and may be required to meet with office staff and physicians as needed. This position monitors the quality of coding and stays current on professional coding changes, compliance issues, billing, documentation, reimbursement, and interpretation of coding/documentation rules.

Primary patient contact is only social. He/she demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant Health Care and the commitment to Extraordinary Care for Every Generation.

• Contributes to organizational success targets for patient satisfaction.
• Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other staff members of encountered departments.
• Adheres to coding rules for coding professional services for multiple specialties (such as neurosurgery, pediatric surgery, rehab, orthopedic, cardiology, etc.), urgent care, occupational health, family practice, and others to ensure quality coding based upon documentation within the patient record.
• Follows policies, procedures, and guidelines to assure consistent coding quality. At the same time utilizes analytical skills when reviewing charts, interpreting documentation, and applying codes, sufficing edits, etc.
• Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others, and the ability to work extra when backlogs occur.
• Participates in HIM department meetings and area‑specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required.
• Assists in achieving departmental, AR, and area‑specific goals.
• Charge entry for professional services (office and/or hospital‑based for acute care, urgent care, specialty care, occupational health, skilled nursing, et. services).
• Supports physicians, leadership, managers and staff on coding and documentation related items. Problem‑solves, researches topics, makes recommendations and provides education as needed.
• Can develop training or education materials.
• Performs E & M, procedural or other specified coding audits for many professional settings and services.
• Helps to identify solutions to problems and assists in resolving issues related to coding.
• Shares knowledge during training of new staff and is a resource to others.
• Independent learning with a desire for continued personal and professional growth. Stays current on coding updates and publications.
• Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.
• Maintains professional credentials.
• Required to provide written and oral feedback to providers on audits, for education, or other as required.
• Must be professional, self‑motivated, and work independently with the ability to make sound decisions, analyze issues, and solve problems.
• Assists CBO/Finance/Data/CMG/Other as requested for follow‑up on items related to coding, billing or reimbursement.
• Ensures that all legal requirements, including Federal (HIPAA) and State regulations, are met.
• Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and Department Policies and Procedures.
• Participates in development and attainment of department and workgroup goals.
• Performs other duties as assigned which may include: working with students, developing policies, guidelines or other documents in…