Coder III, Professional Srvcs

Emory•Atlanta, GA

4d•Onsite

About The Position

This position is accountable for reviewing physician documentation, CPT, HCPCS & ICD10-CM coding. FRONT END CODER: The primary focus of this position will be Advanced Surgical and Interventional Procedures. This position is accountable for the performance of charge capture, including TES edit maintenance and resolution, denial prevention, and go to contact for special projects in order to optimize the revenue potential for the department. Revenue cycle responsibilities include daily functions that contribute to service capture, charge capture (Evaluation & Management expert), management of patient financial information (registration/insurance, referrals, pre-certs etc.), and collection of patient service revenue. Assignments will focus on the most complex and high risk procedures/cases with a strong understanding of anatomy and physiology as well as coverage across multiple specialties. Additional functions include: mentoring those in Coder I and Coder II roles; dividing time between coding, auditing (presenting and defending findings), internal training and external physician education and onboarding; assisting in cross training the coding team and fostering existing/new physician relationships. This role should be an expert in both E&M and procedure coding and be knowledgeable about several related specialties. They must be able to represent coding guidelines (specifically as applicable to the pod) at a high level and participate in proactive revenue issue resolution. The Coder III should be able to work independently and maintain a high level of compliance and quality. This role is often seen as the go to coder for projects and is regularly engaged to enhance charge capture across the whole team. This role will foster collaboration among other coders on the team and providers. The Coder III will be able to maintain all assigned tasks and keep all metrics in expected thresholds. This position reports to the Supervisor or Manager, Revenue Cycle Operations. Employee may be responsible for other duties as assigned.

Requirements

High School Diploma or equivalent.
Coding certificate through nationally recognized organization (AAPC, AHIMA, etc.) required: CCS-P, CPC, RHIA, RHIT, CCS, CPC-H.
An additional specialty certification.
Three years professional coding experience in CPT, HCPCS, and ICD10-CM.
Two years of experience must be in an outpatient specialty or Surgical/Ancillary Diagnostic discipline.
Mandatory training program based on skill set is required upon hire.

Nice To Haves

Preferred working knowledge includes: medical terminology, anatomy and physiology, GE Centricity experience, billing regulations, insurance coverage limitations, managed care protocols, the ability to research unfamiliar procedures and services, Computer Assisted Coding (CAC), introduction to research, Medicare guidelines and billing requirements, medical devices, professional medical society websites, NCCI edit conventions.
Completion of the internal CDP program is preferred.

Responsibilities

Review physician documentation, CPT, HCPCS & ICD10-CM coding.
Perform charge capture, including TES edit maintenance and resolution.
Prevent denials and serve as a contact for special projects to optimize revenue potential.
Manage patient financial information (registration/insurance, referrals, pre-certs etc.).
Collect patient service revenue.
Mentor Coder I and Coder II roles.
Divide time between coding, auditing, internal training, and external physician education and onboarding.
Assist in cross-training the coding team.
Foster existing/new physician relationships.
Represent coding guidelines at a high level.
Participate in proactive revenue issue resolution.
Work independently and maintain a high level of compliance and quality.
Enhance charge capture across the whole team.
Foster collaboration among other coders and providers.
Maintain all assigned tasks and keep all metrics in expected thresholds.