Cert Coding Speclst II-Profee

UPMC

1d•Onsite

About The Position

Purpose: All responsibilities of the Coding Specialist plus works on-site and assists with staff management. Develop new processes and work flows to address issues by analyzing edit/denial data. Effectively communicate in a professional manner with staff, other health care professionals, and management team. Acts as liaison for decentral coding departments. Works with other departments to develop or enhance automated coding and coding interfaces. Assists manager with recruitment and evaluation processes.

Requirements

High school graduate or equivalent.
Graduate of an approved certified coding program preferred.
Proficient computer skills with MS excel knowledge preferred.
5 years surgical coding experience (includes anesthesia coding) or advanced E/M coding experience.
2 years training or supervisory experience required.
CPC or Certified Coding Specialist (CCS) specialty certification required
Certified Coding Specialist (CCS) OR Certified Outpatient Coder (COC) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
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Responsibilities

Demonstrate proficiency on billing system functionality, computer applications and resources essential to completing the coding process.
Lead, participate in and/or assist with departmental coding audits.
Investigate, resolve and analyze edits and denials and provide reports for process improvement, as necessary.
Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc). Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding.
Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling. Prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
Perform staff coding audit, monitors performance and completes summary reports for management.
Complete work assignments in a timely manner and adhere to department charge lag goals and understand the workflow of the department.
Refer problem accounts to appropriate coding or management personnel for resolution.
Supervises staff including assignments and Kronos approval and sign offs, as well as, assist with recruitment.
Train all new Coders to observe established coding guidelines and to utilize the appropriate billing system.
Advise and instruct coders/providers regarding billing and documentation policies, procedures, and regulations; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.
Adhere to internal department policies and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.
Responsible for assigning PQRS codes and assists in the development of templates and processes to obtain the appropriate documentation.
Make forward progress within the training period toward meeting coding accuracy standards of the department within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff.
Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification and provide education to physicians to accurately complete the coding process.