Lead, Professional Services Coder (Casual) - PFS - RCSSD

Rady Children's Hospital • San Diego, CA

209d • $30 - $42

About The Position

Under the general direction of the Supervisor, Professional Billing & Coding and Director, Professional Billing & Coding, this position operates from within the Revenue Cycle Center to address coding issues related to professional billing claims. The incumbent is responsible for reviewing provider charges to ensure accuracy, reduce claim errors & denials while maintaining compliance with CCI & other payer specific coding Edits (McKesson). The incumbent is responsible for reviewing professional surgical coding performed by departmental Professional Services Coders to ensure accuracy. The incumbent will be responsible for identifying trends of incorrect coding & compiling examples. They will develop training guidelines & presentations of coding recommendations based on these identified trends & will meet with physician providers to train & educate. The incumbent will research CCI Edits, coding & payer websites to provide up-to-date information to coding & billing staff, as well as providers. The incumbent will monitor, track & report error & denial trends to Revenue Cycle Leadership. The incumbent will recommend coding changes based on audit & research. The incumbent will assist departments with resolution of claim errors stemming from coding errors. Responsible for processing patient complaints related to a patient account/invoice. Responsible for establishing & maintaining accurate development of procedural coding for clinical services following Federal & State guidelines. Coordinate & delegate workflows of surgical coding staff. Serve as a resource & mentor to the Departmental Certified Coders & billing staff, assisting them with education & coding questions as they arise. Must be knowledgeable in ICD, CPT & HCPCS coding. Must understand & apply all regulations/laws/and standards applicable to coding to ensure appropriate & compliant billing.

Requirements

• H.S. Diploma, GED, or Equivalent.
• 2 Years of Experience.
• Certified Professional Coder.
• Knowledge of coding methodology, abstract coding from medical/chart notes and operative reports.

Nice To Haves

• Associate's Degree.
• 3 Years of Experience.

Responsibilities

• Review provider charges to ensure accuracy and reduce claim errors & denials.
• Maintain compliance with CCI & other payer specific coding edits.
• Review professional surgical coding performed by departmental Professional Services Coders.
• Identify trends of incorrect coding and compile examples.
• Develop training guidelines and presentations of coding recommendations.
• Meet with physician providers to train and educate.
• Research CCI Edits, coding & payer websites to provide up-to-date information.
• Monitor, track & report error & denial trends to Revenue Cycle Leadership.
• Recommend coding changes based on audit & research.
• Assist departments with resolution of claim errors stemming from coding errors.
• Process patient complaints related to a patient account/invoice.
• Establish & maintain accurate development of procedural coding for clinical services.
• Coordinate & delegate workflows of surgical coding staff.
• Serve as a resource & mentor to the Departmental Certified Coders & billing staff.

Benefits

• Competitive compensation based on experience, education, licensure, unique skillsets, organizational need, and internal equity.

What This Job Offers

• Industry: Hospitals
• Education Level: No Education Listed