PROFESSIONAL CODER

The Professional Coder provides timely and accurate clinical and administration data to ensure optimal reimbursement for professional services performed at acute care, inpatient, outpatient, urgent care or physician offices to meet organizational needs.  This position is responsible for ICD10CM diagnosis, CPT-4 coding and charge entry related to coding, documentation, billing and reimbursement issues.  Works as a liaison between centralized billing staff, practice managers and office staff and may be required to meet with the office staff and physicians as needed.  This position is responsible for the monitoring the quality of coding and stays current on professional coding changes, compliance issues, billing, documentation, reimbursement and interpretation of coding/documentation rules.  Primary patient contact is only social.

He/she demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

• Contributes to organizational success targets for patient satisfaction.
• Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients and other staff members of departments encountered.
• Adhere to coding rules for coding professional services for multiple specialties (such as; neurosurgery, pediatric surgery, rehab, orthopedic, cardiology, etc.), urgent care, occupational health, family practice and other to ensure quality coding based upon documentation within the patient record.
• Follows policies, procedures and guidelines to assure consistent coding quality.  At the same time utilizes analytical skills when reviewing charts, interpreting documentation and applying codes, sufficing edits, etc.
• Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe.  This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur.
• Participates in HIM department meetings and area specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required.
• Assist in achieving departmental, AR and area specific goals.
• Charge entry for professional services (office and/or hospital based for acute care, urgent care, specialty care, occupational health, skilled nursing, et. Services).
• Supports physicians, leadership, managers and staff on coding and documentation related items.  Problem solves, researches topics, make recommendations and provides education as needed.
• Ability to develop training or educations materials.
• Performs E & M, procedural or other specified coding audits for many professional settings and services.
• Helps to identify solutions to problems and assists in resolving issues related to coding.
• Shares knowledge during training of new staff and is a resource to others.
• Independent learning with desire for continued personal and professional growth.  Stays current on coding updates and publications.
• Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.
• Maintains professional credentials.
• Required to provide written and oral feedback to providers on audits, for education, or other as required.
• Must be professional, self-motivated, and work independently with the ability to make sound decisions, analyze issues and solve problems.
• Assist CBO/Finance/Data/CMG/ Other as requested for follow up on items related to coding, billing or reimbursement.
• Assure that all legal requirements, including Federal (HIPAA) and State regulations are met.
• Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and Department Policies and Procedures.
• Participates in development and attainment of department and workgroup goals.
• Perform other duties as assigned which may include: working with students, develop policies, guidelines or other documents in order to facility complete and timely gathering of information for clinical, billing or coding.

EDUCATION/EXPERIENCE

Certified Professional Coder (CPC) required or Associates Degree/Certification in medical curriculum with two years coding experience in a professional setting.  May substitute two years ICD9/10CM and CPT-4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 12 months of the start date.

Experience in professional coding setting/physician office setting preferred.

Coding experiences preferred utilizing ICD9/10CM and CPT-4 coding books and references in a professional setting.

Must be able to tolerate working under stress, limited time constraints and with frequent interruptions and deadlines.

Prefers 2 years’ experience in interpreting professional/physician remittance advice statements for all major insurance payers for multiple physician specialties.

KNOWLEDGE/SKILLS/ABILITIES

• Basic computer skills including the ability to search for work related items on line using the internet.
• Knowledge of standard office equipment.
• Knowledge of computer use including EMR, email/Lotus Notes/Outlook, internet, and other software as needed (Word, Excel, Intelicode, Systoc, AAPC, etc.).
• Knowledge/understanding of medical terminology and anatomy.
• Knowledge of third party payer coding and billing reimbursement.
• Knowledge of ICD9/10CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines.
• Demonstrates effective communication methods and skills, both verbally and in writing.   
• Uses appropriate organization/priority setting skills to complete work timely and accurately.
• Practices effective problem identification and resolution skills as a method of sound decision making.
• Demonstrates interpersonal skills required to work with many other people and personalities.
• Requires the ability to use sound judgement, based upon the latest guidelines, federal and state statutes and regulations, as well as hospital and departmental policies.
• Continued growth in many areas.
• Ability to sit and look at computer screen for long periods of time.
• Ability to be flexible to adjust assignments as priorities change.

WORKING CONDITIONS/PHYSICAL DEMANDS

• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• Constant sitting, use of hands to finger, handle and feel.
• Constant hearing and near vision.
• Frequent depth perception, midrange and far vision.
• Frequent color and field of vision.
• Frequent lifting 0-10 lbs.
• Occasional lifting 11-50 lbs.
• Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.
• Occasional twisting, reaching and talking. ICIMCHNonNJ