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Professional CoderJob ID 148109 Date posted 05/04/2018
Position Summary: With oversight from the department manager and exercising independent judgment within the scope of their professional practice, the Professional Coder performs a variety of tasks associated with coding physician charges, and providing coding education to providers in that area. Duties include hands-on coding, documentation review for internal and external audits, coding dictionary updates, rejections and denials, surgical coding, physician or other care provider education, and other coding needs for ICD-9, ICD-10, and CPT? coding of inpatient and outpatient professional charges.
Essential Duties & Responsibilities including but not limited to:
1. Coding Responsibilities:
- Provides review and/or coding of any professional services including but not limited to surgeries, encounters, and diagnostic services for appropriate use of CPT?, ICD-9, ICD-10, HCPCS, and Modifier useage/linkage as well as provide ICD-9 or ICD-10 coding where needed for handwritten/missing diagnoses.
- Provides same for areas where workfiles are used. In areas where paper is used, reconcile daily charges against log (if available/applicable) to ensure daily capture of coding charges expected. Productivity and accuracy for workfile and non-workfile standards must be met according to guidelines set by manager.
- Review and assist in updates of coding dictionaries/encounter forms/charge slips as needed for accuracy of CPT?, HCPCS and ICD-9 or ICD-10 Coding.
- Periodic review of codes, at least annually or as introduced or required
- Answers and responds accurately and timely to questions on the telephone, voice mail, e-mail, Coding Hotline and/or Coding Website as appropriate.
- Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the PFS Department.
- Reports regularly on daily activity, productivity, and findings of reviews/rejections/education via electronic file or database, e-mail, paper, or other means as required by manager.
2. Physician/Provider Education:
- Confers regularly with physicians/care providers, clinical or ancillary managers, coders, or other staff through departmental staff meetings, one-on-one meetings, and/or daily interractive communication to respond to and educate providers on specific departmental and clinic wide coding issues and updates including but not limited to the coding hotline and/or the coding website.
- Participates in new physician/care provider orientation as well as provide follow-up reviews and education for the new physician/care provider if applicable for the area of responsibility.
- Provides feedback, recommendations, and participates as the coding representative for the Professional Coding Department on the Revenue Cycle Teams as requested by manager.
- Develops and conducts a schedule of physician/care provider documentation reviews twice yearly in areas where applicable and/or as defined by manager.
- Provides feedback to the physician/care provider, Department Chair, and/or Adminsitration as required.
- In areas where hands-on coding is performed, documentation review is ongoing and feedback will be provided to the physician/care provider, Department Chair, and/or Adminsitration as required.
3. Education & Professional Development:
- Researches and stays updated and current on CMS, AMA and Local Coverage Determinations (LCD?s), to ensure compliance with coding guidelines.
- Communicates new guidelines to providers through physician/care provider and/or departmental meetings.
- Stays current on CCI Edits, Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
Education: High School Diploma or GED, plus additional specialized training associated with attainment of a recognized Coding Certificate including Medical Terminology, Anatomy and Physiology, and coding coursework.
Licensure, Certification, Registration: None required
Skills, Knowledge & Abilities: Excellent Verbal and Written Communication skills required. Excellent Presentation Skills Required. Basic computer skills required.
About Lahey Health
The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
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