Pro Fee Coding Specialist

Saint Francis Health System

2d•Onsite

About The Position

The Pro Fee Coding Specialist reviews documentation and reviews, adds or corrects diagnosis and procedure codes that have been submitted by the provider. This role utilizes coding knowledge learned through valid coding resources in decision making. This position is ECB status – requires a minimum number of worked hours per month as needed by the department; limited benefit offerings.

Requirements

GED or High School diploma.
None. Experience and/or training in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded, preferred.
2 years related experience, preferred.
Sound knowledge and understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding.
Basic encoder skills.
Knowledge of Microsoft 365 and other applicable software.
Excellent communication skills, both written and verbal that present clear and concise information.
Effective interpersonal, organizational, and multitasking skills.
Ability to determine whether a record is complete enough to code or should be held for more documentation.
Sound ability to be cooperative, dependable and responsive to the changing nature of the coding workflow.
Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines.
The applicant will need to obtain the certification within one year of hire if they do not have a required certification.

Nice To Haves

Experience and/or training in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.
2 years related experience.

Responsibilities

Codes as assigned from review of medical record documentation.
Applies knowledge of current coding and billing requirements to ensure claims are submitted correctly.
Monitors coding and billing performance and resolves denials related to coding errors.
Performs review for charge corrections and rebilling as required for resolution of coding denials.
Develops preventative measures in response to patterns identified through analysis of claims denial data; prepares periodic reports for clinical staff, identifying corrective measures to resolve denial problems.
Advises and instructs providers regarding documentation and billing policies, procedures and regulations; interacts with providers regarding conflicting, ambiguous or none-specific documentation, obtaining clarification of the same.
Educates providers and office staff regarding documentation coding and billing changes and regulations to assure compliance with local, state and national policies.
Works collaboratively with providers, office staff, billing personnel, quality department and compliance, and coding resources to ensure accurate coding.
Stays updated on coding rules, attends seminars and reviews and coding periodicals.