Pro Fee Coding Specialist - Pro Services Coding

Kettering Health•Miamisburg, OH

19h

About The Position

This position, under the direction of the Manager of Professional Services Coding, is responsible for coding compliance and EPIC WQ Reconciliation. The 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. The role involves accurately assessing documentation in the EPIC EMR to assign appropriate CPT, HCPCS, and ICD-10 codes. It also includes reviewing and researching pending and denied claims related to professional fee coding, CMS NCCI edits, and medical necessity requirements. The specialist is expected to demonstrate initiative in maintaining current knowledge of coding standards and regulations, correspond with providers to resolve pending claims, and participate in departmental goals and the KHN mission. Effective communication with providers, leaders, and staff is essential, as is timely research and resolution of concerns.

Requirements

High School Diploma or equivalent
RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification
Prior experience in professional fee coding/billing
Knowledge of CPT, HCPCS, Modifiers, ICD-10, and CMS NCCI Edits
Knowledge of Medical Terminology and Anatomy & Physiology
Knowledge of Computer and EPIC Applications
Excellent verbal and written communication skills
Ability to perform Charge Review WQ
Ability to perform Claim Edit WQ
Ability to perform Follow Up WQ (Denials)

Responsibilities

Coding compliance and EPIC WQ Reconciliation
Serve as the subject matter expert ensuring coding compliance and knowledge of CMS billing rules and regulations
Serve as a professional fee coding resource to network service lines
Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10
Review and research pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements
Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
Correspond with providers on pending claims to facilitate resolution
Participate in departmental goals, KHN mission and implemented KHN/KPN policies
Communicate appropriately with providers, leaders, and staff
Research and resolve concerns timely
Review, research and respond to Charge Review WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution
Correspond and communicate appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution
Review, research and respond to Claim Edit WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution
Review, research and respond to Follow Up WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution
Follow procedures pertaining to position