Professional Coder

Brown University Health • Providence, RI

71d • $21 - $35

About The Position

The Coding Specialist reports to the Manager of Physician Coding. Ensures that appropriate diagnostic and procedural codes (CPT-4, ICD-9/10, HCPCS) are submitted for professional charges resulting in accurate claims processing, data retrieval, and analysis. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.

Requirements

• High school diploma or equivalent.
• Successful completion of formal education in medical coding.
• Certification from the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other association required.
• One year medical billing experience in a hospital, medical office, or billing company, or the equivalent.
• Coding experience preferred.
• Training in anatomy, physiology and disease processes preferred.
• Ability to analyze patient record and to recognize and analyze clinical documentation pertinent for coding.
• Writing skills sufficient to prepare physician queries.
• Computer skills to research internet websites to clarify diseases or procedures and to access payer policies.
• Ability to use computer applications, including Excel, Word, Adobe Reader, Microsoft Outlook and third party payer websites.
• Previous Epic experience a plus.

Responsibilities

• Assesses the adequacy of the documentation for the provider visit or procedure which supports the diagnosis.
• Reviews procedure codes selected by the provider for hospital services and complex office services, all diagnoses for medical necessity and adequate specificity.
• Queries providers when documentation in the patient record is inadequate, unclear, does not support the code assigned, or indicates that additional services were performed that were not coded.
• With provider consent, corrects and revises codes, as necessary, to ensure compliance with federal law and payer guidelines and requirements and to ensure optimal reimbursement.
• Refers coding, billing, and system questions to the Manager after exhausting own efforts to answer them by referencing appropriate coding publications and other resources.
• Performs audits of provider coding and documentation, as required, and educates providers regarding improvement in both.
• Remains current with coding guidelines and documentation requirements.
• Maintains coding certification by earning required continuing education units.
• Performs other related duties, as assigned.

Benefits

• Equal Opportunity employer
• Consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: High school or GED