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Project Specialist CodingJob ID 148113 Date posted 05/16/2018
Position Summary: With oversight from the department Supervisor, Manager and/or Directors exercising independent judgment within the scope of their professional practice, the Certified Professional Coder performs a variety of tasks associated with coding physician and other provider charges, and providing coding education to providers in that area. Duties include standard coding, documentation review, coding dictionary updates, rejections and denials, surgical coding, physician or other care provider education, and other coding needs for ICD-10 and CPT coding of inpatient and outpatient professional charges.
Performs complex specialized tasks, conducts audits, appeals, and peer/provider education.
Essential Duties & Responsibilities including but not limited to:
Specialty Coder duties:
- Takes on and handles independently complex tasks around specialized (e.g. differentiated by clinical area) documentation review working directly with departments and providers
- Performs audits independently and translate them into revenue opportunities, and develops and presents training for, both, peers and providers, management, etc.
- Reviews and/or assigns complex denials/appeals that require coordination with the clinical department, providers, and the hospital/HB Billing. Manages independently the various denial work queues. Generates and/or processes denial reports and recognizes trends in these reports and prepares data for management and denial committees.
- 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-10, HCPCS, and Modifier useage/linkage as well as provide 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-10 Coding.
- Periodic review of codes, at least annually or as introduced or require for new, revised, or deleted code updates.
- 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.
- 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 in areas where applicable and/or as defined by manager.
- Provides feedback to the physician/care provider, Department Chair, and/or Adminsitration as required.
- Documentation review is ongoing and feedback will be provided to the physician/care provider, Department Chair, and/or Adminsitration as required.
- Education & Professional Development:
- Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD?s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
- Communicates new guidelines to providers through physician/care provider and/or departmental meetings.
- Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
- Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
Education: High School Diploma or equivalent, plus additional specialized training associated with attainment of a recognized Coding Certificate. Associate Degree or above preferred.
Licensure, Certification, Registration: CPC (Certified Professional Coder through American Academy of Professional Coders) or CCS-P (Certified Coding Specialist Physician based through American Health Information Management Association)
Additional specialty certification preferred.
Skills, Knowledge & Abilities:
- Demonstrates above average understanding of the body of knowledge required for attainment of a college-level coding certificate as indicated above.
- Computer skills, including word processing, spreadsheets, data entry, research, reporting, and accessing multiple hospital-wide systems.
- Excellent oral and written communication skills.
- Demonstrates proficiency as a teacher and/or educational resource to others in sharing knowledge and providing direction within the scope of the job.
- Demonstrates a high level of independence and specialized knowledge.
- Expert level knowledge of EHR systems such as Epic.
- The Certified Professional Coder III is a self-starter, conducts analytical and strategic tasks such as identifying root cause workflow and systems issue, process improvement identifiction. Maintains an above average output and/or specialized knowledge in the respective area of Professional Coding.
Experience: Minimum 3 years Professional Coding/Revenue Cycle experience in conjunction with requirements indicated above;
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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