Pro Fee Coding Spec - Professional Svc Coding

Kettering Health Network•Miamisburg, OH

About The Position

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits Corresponds with providers on pending claims to facilitate resolution Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies Communicate appropriately with providers, leaders, and staff Researches and resolves concerns timely

Requirements

High School Diploma or equivalent
RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification
Prior experience in professional fee coding/billing
Knowledge and Skill: CPT, HCPCS, Modifiers, ICD-10, and CMS NCCI Edits
Medical Terminology and Anatomy & Physiology
Computer and EPIC Applications
Excellent verbal and written communication skills
Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits

Responsibilities

Coding compliance
EPIC WQ Reconciliation
Subject matter expert ensuring coding compliance
Knowledge of CMS billing rules and regulations
Professional fee coding resource to network service lines
Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10
Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]
Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
Corresponds with providers on pending claims to facilitate resolution
Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies
Communicate appropriately with providers, leaders, and staff
Researches and resolves concerns timely
Charge Review WQ [Edits] Reviews, researches and responds to Charge Review WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Claim Edit WQ [Edits] Reviews, researches and responds to Claim Edit WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Follow Up WQ [Denials] Reviews, researches and responds to Follow Up WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.
Departmental Responsibilities Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies
Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
Follow procedures pertaining to position