Charge Capture Coding Specialist

UMass Memorial Health•Worcester, MA

2d•Onsite

About The Position

Interprets clinical and diagnostic documentation in order to process or pro-fee charges for episodes of outpatient /inpatient care. Assigns appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers, as appropriate adhering to official coding guidelines.

Requirements

High School diploma or equivalent
Successful completion of a Medical Billing and Coding Program.
Coding Certification in Professional Coding or must be obtained within 6 months of acceptance as a condition of employment.
Medical terminology.
Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits.
Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
Good interpersonal and communications skills and demonstrates professionalism
Good customer service skills with the ability to communicate efficiently.
Good organizational skills with attention to detail.
Ability to work independently within established guidelines.
Ability to problem solve, organize and prioritize workload to meet productivity benchmarks.

Nice To Haves

One (1) year of medical abstraction and outpatient coding experience or related work experience.

Responsibilities

Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers as defined by official coding guidelines and other recognized reference materials, i,e, Optum Encoder, CCI edits, leveling, etc.
Verifies documentation is present to substantiate codes assigned.
Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
Participates in the continuous coding audit and performance management program.
Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
Communicates to Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
Refers all unusual, questionable situations to the direct Supervisor/Manager.
Alerts management to any coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken.
Adheres to the coding and billing regulations established by the American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
Keeps current with all coding updates and information related to correct coding.