BH Coding Specialist II

GENERAL SUMMARY:

Responsible for accurate and compliant assignment of CPT and ICD 10 codes supported by provider documentation in the medical record utilizing the current year International Classification of Diseases Manual (ICD-10) and the current year American Medical Association's Current Procedural Terminology manual (CPT) ensuring optimal reimbursement.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. Adheres to all relevant Bryan Health/Bryan Heart policies and procedures.

3. *Accurately assigns and sequences diagnosis and procedure codes to arrive at the correct Ambulatory Payment Classification assignment - utilizing provider supporting documentation.

4. Maintains coding certification by performing continuing educational requirements as defined by certifying body/organization.

5. *Maintains thorough understanding of Government and commercial payer documentation, coding and reimbursement guidelines, CCI edits, MUE's, NCD's and LCD's.

6. Achieves and consistently maintains departmental productivity/performance goals and metrics.

7. Complies with Bryan Heart Coder Audit/Competency Program.

8. *Analyzes, researches and performs payer follow up tasks specific to coding denials (including but not limited to bundling/medical necessity/non-adherence to payer coding and reimbursement guidelines).

9. Assists with monitoring payer denial trends and development of denials management process.

10. Regularly advises direct report supervisor/director of concerns including but not limited to provider documentation content and timeliness to complete, payer performance, system functionality and any other identifiable barriers to performance thus negatively influencing the organizational goals and metrics.

11. *Provides timely feedback to providers when identifying documentation concerns or inaccurate assignment of procedure codes.

12. Actively participates in meetings to build a cohesive team by responding to inquiries, making recommendations, sharing observations and respecting team members input.

13. Assists as requested with auditing activities.

14. Reviews and reports new, deleted, or inactivated procedure codes to appropriate team members.

15. Participates and completes mandatory annual training as assigned by Bryan Heart/Bryan Health.

16. Develops and fosters relationships with providers and clinical support staff.

17. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

18. Participates in meetings, committees and department projects as assigned.

19. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Certification as a Certified Coding Associate (CCA) required. Certification as a Certified Coding Specialist (CCS or CCS-P) or Certified Professional Coder (CPC) preferred. Minimum of five (5) years coding experience in a medical environment required. Cardiology/Cardiothoracic/Vascular coding experience preferred.