Pro Fee Coding Specialist

Saint Francis Health System

169d

About The Position

The Pro Fee Coding Specialist reviews medical record documentation and reviews, adds, or corrects diagnosis and procedure codes submitted by providers. The role applies coding knowledge and valid coding resources to make coding decisions. The specialist codes assigned records, supports accurate claim submission, monitors coding and billing performance, and resolves coding-related denials. The position also works with providers and office staff on documentation, coding, billing policies, and regulatory changes, and collaborates with billing, quality, compliance, and other coding resources.

Requirements

High school diploma or GED.
Hold one of the following credentials, or obtain a required certification within one year of hire: CCS, CPC, BCHH-C, RHIA, RHIT, or HCCS.
Sound knowledge of medical record content and the ability to locate information that supports coding or provides coding specificity.
Basic encoder skills.
Knowledge of Microsoft 365 and other applicable software.
Excellent written and verbal communication skills, presenting clear and concise information.
Effective interpersonal, organizational, and multitasking skills.
Ability to determine whether a record is sufficiently complete to code or should be held for additional documentation.
Ability to be cooperative, dependable, and responsive to changes in coding workflow.
Ability to work independently and collaboratively in a fast-paced environment while managing multiple priorities and competing deadlines.

Nice To Haves

Experience and/or training in anatomy and physiology and disease processes relevant to understanding the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.
Two years of related experience.

Responsibilities

Code assigned records based on medical record documentation.
Apply current coding and billing requirements to help ensure claims are submitted correctly.
Monitor coding and billing performance and resolve denials related to coding errors.
Review charge corrections and rebilling as needed to resolve coding denials.
Analyze claims denial data, develop preventative measures, and prepare periodic reports for clinical staff with corrective measures.
Advise and instruct providers on documentation and billing policies, procedures, and regulations.
Work with providers to clarify conflicting, ambiguous, or nonspecific documentation.
Educate providers and office staff about documentation, coding, and billing changes and regulations to support compliance with local, state, and national policies.
Collaborate with providers, office staff, billing personnel, the quality department, compliance, and coding resources to support accurate coding.
Stay current on coding rules by attending seminars and reviewing coding periodicals.