Physician Medical Coding Specialist I

Genesis Healthcare System

11d

About The Position

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. Position Details: Work Shift: Varied Shift (United States of America) Scheduled Weekly Hours: 40 Department: Physician Coding Overview of Position: Works day-to-day on assigned charge review WQ’s to review Physicians, Nurse Practitioners and Physician Assistants documentation thoroughly, assigns the appropriate Evaluation and Management code, CPT procedure codes, HCPCS procedure codes, modifiers, and ICD-10 diagnosis code(s) to ensure optimal, correct, and timely coding. Codes medical claims per documentation, daily reconciliation and investigating and resolving denials.

Requirements

High School diploma or GED required.
Minimum of one (1) year experience working in the Physician based coding field or must be certified in one of the following: CPC, CCS-P, or RHIT (or related certification), or must obtain within 12 months from date of hire.
Knowledge of medical terminology and anatomy and physiology.
Demonstrates understanding of various coding and reimbursement systems, including ICD-10-CM, CPT and HCPCS required.
Ability to analyze and interpret clinical data.
Demonstrates critical thinking skills to make appropriate interventions.
Excellent verbal and written communication skills.
Demonstrates data entry skills, with knowledge of various software applications, including Microsoft Excel, Word, and Power Point.
Ability to work independently.

Nice To Haves

Knowledge of EPIC electronic medical record and 3M encoder preferred, but not required.

Responsibilities

Adheres to the ICD-10-CM coding conventions, official coding guidelines, CPT rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets.
Reviews and applies coding and reimbursement resources in a timely manner to ensure an up-to-date knowledge base.
Assigns and reports codes that are clearly and consistently supported by provider documentation in the electronic health record.
Discerns clinical notes, uses skills, and knowledge of currently mandated coding and classification systems, and office resources to select the appropriate diagnostic and procedural codes.
Responsible for working assigned Charge Review WQ’s daily and maintain average aging day expectation.
Responsible for working assigned denials daily and applying knowledge from denials to day-to-day coding work.
Responsible for reconciling hospital rounding/surgical charges to ensure all revenue is being captured daily.
Collaborates with the physician coding auditor and educator on educating providers and other clinicians by advocating proper documentation practices, further specificity and re-sequencing or inclusion of diagnoses or procedures to more accurately reflect the acuity, severity and occurrence of events.
Actively participates in new provider coding and documentation education and in collaboration with the physician coding auditor and educator.
Queries providers for clarification/additional documentation prior to code assignment when there is conflicting or ambiguous data in the electronic health record.
Ensures accurate, complete, and consistent coding practices for the production of quality healthcare data.
Consistently applies and optimizes coding based upon compliant reimbursement guidelines.
Identifies and reports inappropriate coding practices.
Routinely abstracts clinical information from the medical record according to department procedure.
Assists in training of other staff in computer applications and department procedures.
Establishes report parameters to produce meaningful data.
Verifies patient identity to ensure correct filing of patient information.
Adheres to the Physician Coding and Education Quality Assurance policy and procedure.
Adheres to the Physician Coding and Education Productivity Measures policy and procedure.
Adheres to the Physician Coding Code Change policy and procedure.
Adheres to the Physician Coding Query Escalation policy and procedure.
Adheres to the Physician Billing and Coding Denial Escalation policy and procedure.
Adheres to the Physician Billing and Coding Rebill policy and procedure.