TCHP Coder Senior

Interpret clinical documentation/records from patient records to ensure all diagnoses and procedures are documented and coded accurately.   Ensure highest level of reimbursement practice efficiencies and compliance related to coding procedures. Provide feedback and support to physicians.

Responsibilities

Responsible for translating healthcare providers’ diagnostic and procedural documentation into coded form, applying regulatory and organizational guidelines.

Review patient reports and extract data necessary to apply appropriate ICD and CPT codes for billing, internal and external reporting, research and regulatory compliance. 

Utilize technical coding principals and reimbursement rule expertise to assign appropriate ICD diagnosis and CPT procedures in multiple specialties, with thorough understanding all elements in E/M coding with ability to audit for correct E/M level selection..

Regularly communicates with the healthcare provider to ensure documentation and coding accurately reflect care rendered including office point of contact.

Facilitates healthcare provider education in areas of CMS regulations, coding, billing, documentation and administrative guidelines.

Code at a productivity and quality rate consistent with organizational standards.

Identify and research encounters with potential TCHHN inpatient related bills to ensure compatibility and compliance.   Discuss discrepancies with facility coder to determine appropriate coding – using opportunities to teach and/or learn.  Assist in workflow improvement activities.

Manages assigned provider workload in coding workflow within Epic

Analyze denial and rejection trends when necessary to ensure compliance with payor and/or regulatory requirements. 

Monitor documentation and coding practices to identify and follow up on potential coding related compliance issues and/or missed revenue potential.

Maintain current knowledge base in all aspects of CPT, HCPCS and ICD -10-CM coding.  Provide education as indicated.

Keep abreast of all current billing and coding rules and regulations affecting government and non-government payers and disseminates information to appropriate individuals as needed.  Reviews and researches coding/billing issues, including but not limited to, rejection reports and claim denials.  Perform regular analysis of the impact of coding and clinical documentation on reimbursement and identifies trends and opportunities for improvements.

Adhere to compliance regulations, the Christ Hospital Code of Conduct, and the Christ Hospital Core Values and AHIMA code of Ethics while performing all duties detailed.

Qualifications

KNOWLEDGE AND SKILLS:

Requires a working knowledge of Medicare regulations on charging and billing practices (UB92 and 1500/HCFA), knowledge of CPT and HCPCS coding, and the ability to read/analyze itemized billing statements, medical records, & lab reports.  Critical thinking skills needed to independently conduct Opportunity Assessments in new areas of charging.  Must be detailed-oriented, and have the ability to work in team environment and work toward team goals.  Ability to summarize findings and present for appropriate intervention and education.  Proficiency in Microsoft Office applications required.  Experience with LastWord and Groupwise helpful.  Ability to learn and work with “Charge Capture” software (as available in market).  

EDUCATION: 

Skills assessment required to determine competency level of coding skills. Certified Professional Coder (CPC) or Certified Coder Specialist-Physician (CCS-P) required

YEARS OF EXPERIENCE: 2 years coding experience required, 5 years related experience in multiple specialties preferred.

REQUIRED SKILLS AND KNOWLEDGE: 

• Demonstrated in depth knowledge of HCPCS, ICD-10 and CPT coding guidelines, medical terminology, anatomy and physiology.

• Ability to accurately code diagnosis, diagnostic and surgical procedures in multiple specialties with a depth of knowledge in Evaluation and Management (E/M) coding.

• Strong knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation

• Demonstrated effective verbal and written communication skills, including with physicians and groups.

• Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex coding and healthcare issues.

• Demonstrated ability to effectively work within a team environment, using excellent written, verbal, and presentation skills to share audit findings, risk areas, and compliance issues with coders, office managers, physicians, etc..

• Maintains confidentiality and protects sensitive data at all times.         

LICENSES & CERTIFICATIONS: 

(same as education)