Professional Coder-Certified

CENTERS FOR PAIN CONTROL•Valparaiso, IN

About The Position

PURPOSE: Reporting to the Billing Team Supervisor, the professional coder is responsible for reviewing clinical documentation to abstract and/or validate CPT and ICD-10 coding for office based and outpatient professional services. ACCOUNTABILITIES AND JOB ACTIVITIES: Ensure that medical coders are trained, knowledgeable and consistently adhering to key responsibilities relevant to job description Train new employees Perform ongoing training and education as needed Conduct audits to ensure the accuracy of the coding team and re-train and/or initiate coaching if necessary Monitor daily workload to ensure that claims are created in a timely manner Ensure that professional and facility service claims are created on a daily basis without interruption Responsible for alerting proper parties if any interruptions are discovered Analyze office progress notes, procedural and operative records to identify and independently assign accurate ICD and CPT/HCPCS codes while adhering to ICD-10-CM, CPT and all appropriate government coding guidelines, in addition to adhering to all CPC/IPM coding/billing policies and procedures Resolve coding related edits in the AthenaOne practice management system by applying the aforementioned rules, policies and procedures Abstract pertinent information into the billing system accurately and timely Maintain compliance with Federal, State and Payer regulations Serve as a subject matter expert to the coding team and clinicians as needed Keep abreast of current coding changes, documentation requirements and payer policies within designated specialties Demonstrate the ability to educate/train coding staff, physicians and mid-level providers as needed Assist with coding denials received from payers Identify denial trends and educate the coding team and/or request system edits as needed Appeal claims as needed and assist with the development of letters of medical necessity as required Assist with charge capture initiatives by monitoring services performed to assure all encounters are captured, coded and billed within timeframes established by CPC/IPM Monitor all AthenaOne claim worklists to ensure that charges are being worked in a timely fashion and alert management team as needed if any concerns are identified Attend meetings and training sessions virtually or by traveling to provider and business locations as needed Develop and maintain personal and professional skills Attend all mandatory staff meetings per year unless excused as evidenced by documentation Attend mandatory in-services and a minimum of two pertinent in-services per year as documented Actively participate in performance improvement activities as observed or documented Establish realistic professional goals as evidenced by the annual performance evaluation Actively keep abreast of departmental and organizational activities Demonstrate flexibility in response to unexpected change in workload or situations as observed Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle Assist in the orientation of new personnel as directed Support the mission and goals of the company as observed Address all emails within 24 hours as documented Perform other duties as required Demonstrate safe and cost-effective practice Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed Consistently utilize proper body mechanics as observed Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart Consistently allocate resources to reduce waste and minimize costs as observed Consistently complete assigned duties within stated shifts in a timely manner as observed and documented BEHAVIORAL EXPECTATIONS Strive for excellence Set challenging goals Produce quality work in a timely fashion Maintain current knowledge and skill Participate in quality and process improvement efforts Keep the work area clean, safe and secure Act Flexibly Adapt to change See the value of different opinions and new ideas Change plans and objectives given new direction or priorities Handle stressful situations effectively Meet Customer Needs Meet internal and external customers’ needs Find new ways of satisfying customers Participate in service improvements efforts Listen and respond to customers Treat customers with compassion and respect Work as a Team Work as a team player Pitch in to help those in need Communicate with others appropriately Listen and respond to others Handle conflict situations effectively Foster trust and respect within the team Participate in committees and task forces Foster Diversity in the Workforce Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability Treat all associates and customers fairly Be Self-directed Take initiative and responsibility for actions Identify own learning needs and create/implement Learning Plans Perform duties according to policies and procedures Demonstrate ethical behaviors Maintain confidentiality of information Maintain licenses and certifications as appropriate Fulfill operating unit/clinical competencies Use equipment/resources responsibly You must refer to upper management for approval or final disposition on the following Change in procedure Difficult patient situations Any situation you are unsure of

Requirements

Knowledge of Electronic Medical Record
Good typing skills
Good internet navigation skills
Knowledge of instrumentation used in office (fax, credit card, copy)
Knowledge of multi-line phone system
Excellent Verbal and Written Communication skills
Knowledge of medical terminology with a strong focus on the spine and skeletal system.
Advanced knowledge and skill in CPT, ICD-10-CM and HCPCS code assignment
Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing, with demonstrated ability to interpret such guidelines
5 years of experience with research, analyze, interpret, and abstract data/documentation
Ability to collaborate with cross functional teams and departments
Good problem-solving skills
Certified Professional Coder (CPC) or Certified Coding Specialist-Physician based (CCS-P) preferred
High School diploma or equivalent
5 years of professional coding experience in a physician practice setting.
2 years of current direct supervisory experience as a Billing/Coding/Reimbursement Supervisor with assigned direct reports
5 years of experience with ICD-10, CPT and HCPCS.
5 years of experience in medical terminology.
5 years of experience of Explanation of Benefits and CMS 1500 form.
Fast paced work environment with established time constraints
Must be able to work overtime when required
Must be able to multitask while maintaining accuracy
Must work well with others

Responsibilities

Ensure that medical coders are trained, knowledgeable and consistently adhering to key responsibilities relevant to job description
Train new employees
Perform ongoing training and education as needed
Conduct audits to ensure the accuracy of the coding team and re-train and/or initiate coaching if necessary
Monitor daily workload to ensure that claims are created in a timely manner
Ensure that professional and facility service claims are created on a daily basis without interruption
Responsible for alerting proper parties if any interruptions are discovered
Analyze office progress notes, procedural and operative records to identify and independently assign accurate ICD and CPT/HCPCS codes while adhering to ICD-10-CM, CPT and all appropriate government coding guidelines, in addition to adhering to all CPC/IPM coding/billing policies and procedures
Resolve coding related edits in the AthenaOne practice management system by applying the aforementioned rules, policies and procedures
Abstract pertinent information into the billing system accurately and timely
Maintain compliance with Federal, State and Payer regulations
Serve as a subject matter expert to the coding team and clinicians as needed
Keep abreast of current coding changes, documentation requirements and payer policies within designated specialties
Demonstrate the ability to educate/train coding staff, physicians and mid-level providers as needed
Assist with coding denials received from payers
Identify denial trends and educate the coding team and/or request system edits as needed
Appeal claims as needed and assist with the development of letters of medical necessity as required
Assist with charge capture initiatives by monitoring services performed to assure all encounters are captured, coded and billed within timeframes established by CPC/IPM
Monitor all AthenaOne claim worklists to ensure that charges are being worked in a timely fashion and alert management team as needed if any concerns are identified
Attend meetings and training sessions virtually or by traveling to provider and business locations as needed
Develop and maintain personal and professional skills
Attend all mandatory staff meetings per year unless excused as evidenced by documentation
Attend mandatory in-services and a minimum of two pertinent in-services per year as documented
Actively participate in performance improvement activities as observed or documented
Establish realistic professional goals as evidenced by the annual performance evaluation
Actively keep abreast of departmental and organizational activities
Demonstrate flexibility in response to unexpected change in workload or situations as observed
Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle
Assist in the orientation of new personnel as directed
Support the mission and goals of the company as observed
Address all emails within 24 hours as documented
Perform other duties as required
Demonstrate safe and cost-effective practice
Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed
Consistently utilize proper body mechanics as observed
Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart
Consistently allocate resources to reduce waste and minimize costs as observed
Consistently complete assigned duties within stated shifts in a timely manner as observed and documented