Professional Coding Analyst, 40hrs/wk, Lincoln

JOB DESCRIPTION

Job Title: Professional Coding Analyst                                                      
Job Code:  880216  
Immediate Supervisor: Patient Financial Services Manager                        
Status:  Non-exempt                         

DEPARTMENT FUNCTION/JOB OVERVIEW

Responsible for professional fee coding for all inpatient and outpatient professional services in accordance with regulatory coding guidelines and Madonna policy and procedures.  Responsible for submission of accurate visit coding documentation to include CPT, ICD 10-CM, and HCPCS codes based on current coding guidelines.  Responsible to provide billing and reimbursement expertise and ensure compliance with national/state standards and regulations.  . Responsible for internal audits to monitor clinician understanding of coding guidelines. Responsible for the annual update of the professional fee coding processes based on coding changes and education of physician service staff of those changes.  Responsible to maintain knowledge of current CMS regulations for professional fee billing and provide relevant education to physicians and staff. Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures.  This position represents Madonna by adhering and upholding the organizationâ??s Mission, Vision and Values. Supports co-workers, engages in positive interactions and provides helpful assistance to all customers.

ESSENTIAL FUNCTIONS

1. Demonstrate extensive knowledge of official coding guidelines established by the American Medical Association and Centers for Medicare and Medicaid Services [CMS] with regard to the assignment of ICD-10 and CPT codes.
2. Evaluates medical record documentation to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support provider charges.
3. Respond to coding questions/issues from clinical staff and other departments as necessary.
4. Performs scheduled audits of physician coding and documentation to make recommendations for improvement.
5. Interprets clinical data using working knowledge of anatomy, physiology, disease process and medical terminology.
6. Assigns correct procedure and diagnosis codes based on interpretation of procedures and correct coding principles.
7. Assist department leadership with research, analysis, and other projects.
8. Enters professional charges into patient accounting system as requested.
9. Send communication/queries to providers to clarify documentation and coding to ensure accuracy and maximize reimbursement.
10. Develops reports and submits monthly data to manager to include (but not limited to) diagnosis code accuracy, E&M coding accuracy, and audit results.
11. Maintain current and complete knowledge of the accounts receivable system.
12. Communicate professionally and timely with internal and external customers.
13. Identify learning opportunities and provide education for clinicians based on reviews and audits of documentation.
14. Develop educational offerings for physician services support and billing staff related to basic coding guidelines and annual changes of those guidelines.
15. Communicates with and advises Director and/or Manager of situations which may impact department and facility.
16. Support co-workers and engage in positive interactions.
17. Remain calm under pressure and effectively deal with difficult situations.
18. Follows instruction from supervisor to perform other functions as assigned in order to achieve the goals and vision of Madonna Rehabilitation Hospital.
19. Must be able to operate computer, copier and telephone.
20. Demonstrate proficient computer skills, including e-mail, word processing, spreadsheets and/or healthcare billing software.
21. Maintain and ensure a safe environment for the department.
22. Handle and operate all necessary equipment and perform required duties according to established safety standards to maintain compliance with regulations to prevent injury.
    
    
    PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS
    
23. Sedentary work.  Work and move among departments of the organization.  Excellent hand/eye coordination needed.  Lift up to 25 pounds occasionally.  Manual dexterity to operate personal computers and standard office machines.
24. Near acuity and accommodation are required for reviewing medical records, transferring information from paper to computer, from computer to computer and from paper to computer.
25. Reaching, bending, and balancing to read and file are required.
26. Talking and hearing are essential for giving information and taking information in person and on the telephone.
    
    
    QUALIFICATIONS (Education/training and/or Experience)
    
    Education required
    High school diploma or equivalency required. Prefer post-secondary education courses in Health Information Management, accounting and/or business. Educational coursework in CPT and ICD coding in a medical practice and a thorough understanding of medical terminology, anatomy and physiology.  
    
    Preferred credentials
    RHIA, RHIT, CCS, CCS-P, or CPC (Certified Professional Coder)
    
    Experience required
    Minimum of one year of medical coding experience in a physician office setting or equivalent.
    
    Experience preferred
    Medical record audit experience related to professional fee coding.
    
    Skills required
    Knowledge of CMS Regulations for Professional Fee billing. 
    Knowledge of anatomy and physiology and disease pathology. 
    Ability to code utilizing ICD-10 CM and CPT E&M codes. 
    Knowledge billing principles (Accounts Receivable, claim submission, denial appeal process). 
    Understanding of the use of HCPCS codes. 
    Excellent communication skills (verbal and non-verbal. 
    Excellent organizational skills. 
    Familiarity with the use of PC based coding application.
    
    Background checks are conducted.  When specific authorization forms are requested so that full background and history can be obtained, employees/applicants must sign the form(s) requested.