Certified Surgical Coder

Best Care•Omaha, NE

2d•Onsite

About The Position

Codes professional charges for surgical procedures for inpatient and outpatient services including correct CPT, ICD-10-CM, and modifiers in accordance with medical policies and guidelines.

Requirements

High School Diploma or General Educational Development (G.E.D) required.
College level completion of courses in anatomy and physiology, biology, disease process, and medical terminology required.
3+ years previous experience coding physician services from documentation preferred, surgical and Evaluation/Management (E/M) required.
Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Registered Health Information Tech (RHIT) or certified Coding Associate (CCA) or Certified Coding Specialist-Physician-based (CCS-P) required.
Ability to note detail when reviewing the medical record, verifying the diagnosis and reviewing charges at the time of ICD-10-CM and Current Procedural Terminology (CPT) code assignment.
Understanding of outpatient prospective payment methodology, and knowledge of the national correct coding initiatives.
Skills necessary to operate a personal computer and Microsoft Office programs.
Experience with personal computer and knowledge of Word, Excel, etc.

Nice To Haves

Associate's Degree in Health Information Management or healthcare related degree preferred.

Responsibilities

Assigns ICD-10-CM diagnosis, Current Procedural Terminology (CPT) procedure codes, and Healthcare Common Procedure Coding System (HCPCS) device codes as necessary to outpatient records to ensure maximum reimbursement, utilizing ICD-10-CM and Current Procedural Terminology (CPT) principles of code assignment and Uniforms Hospital Discharge Data Set (UHDDS) definitions of principle and secondary diagnosis.
Accuracy rate of at least 95%.
Enters ICD-10-CM diagnosis code(s) and Current Procedural Terminology (CPT) procedure code(s) into the code summary to maintain disease and operation index, to allow for timely submission of claims to insurance companies by assigning correct diagnosis and procedure codes and the reason for the encounter per department procedure.
Accuracy rate of at least 95%.
Reviews Current Procedural Terminology (CPT) procedure codes and Healthcare Common Procedure Coding System (HCPCS) device codes in the code summary and charge viewer to ensure all accounts reflect appropriate charges for services and devices provided; by reviewing Correct Coding Initiative (CCI) edits, attaching modifiers and adding or modifying charges to the account.
Reviews hospital billing charges with physicians to ensure accuracy by checking charges and services, answering questions and advising on any insurance billing updates.
Reviews coding with Physician 95% of the time.
Per provider request.
Per departmental audit standards.
Investigates claim denials from third party payers to ensure accuracy by reviewing services patient received and patient account and making any coding/charging corrections.
Per department process regarding code reviews within 14 days of receipt.
Per request from clinic personnel.
Per request from Business Office and/or Customer Service Personnel.
Ensures timely submission of claims to insurance companies by performing job functions #1 by maintaining Accounts Receivable within 3 days of discharge on all outpatient encounters.
Maintains a minimum productivity standard of: Codes 7 OPS encounters per hour. Codes 5 OBS encounters per hour. Codes 12 Infusion Center encounters per hour. Codes 10 GI/Pain Management encounters per hour. Codes 30 Radiology/OP Diagnostic services encounters per hour. Codes 15 Recurring encounters per hour. Codes 30 Radiology/OP Diagnostic services encounters per hour. Codes 25 Non-patient Pathology Encounters per hour. Codes 15 Emergency Department encounters per hour. Codes 12 Professional Services encounters per hour.
Utilizes and understands how to view and make appropriate changes in charge viewer to ensure maximum reimbursement.