Professional Services Coder III

Company: Taylorville Memorial Hospital
Location: Decatur
Posted on: August 6, 2022

Job Description:

Overview

Provides documentation review, coding and billing services to in accordance with DMG's compliance plan, following its policies and procedures, official and regulatory coding guidance. Understanding and accurate use of approved coding guidelines is paramount to successful performance in this position.

Qualifications

Education and/or Other Requirements

* Minimum High School Diploma or equivalency. College degree and / or extended education in an allied health field preferred.
* Possess an established coding credential from AAPC (CPC) or AHIMA (CCS-P) or Certified Professional Coder - Apprentice, pertaining to professional fee coding and remain in good ethical standing, by obtaining the necessary continuing educational certification requirements.
* Five (5) or more years' experience in healthcare billing, coding and / or reimbursement follow up activities for professional coding services.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

* Knowledge of ICD-10-CM and CPT/HCPCS coding systems.
* Knowledge of medical terminology, pharmacology, pathophysiology and Anatomy and Physiology.
* Understanding of medical records content, format and other pertinent procedures.
* Knowledge of pertinent reimbursement systems, including but not limited to Medicare and Medicaid Physician Fee Schedule and RBRVU system.
* Knowledge of EMR systems and the ability to learn the DMH / DMG EMR system(s) efficiently.
* Knowledge of encoder software tools for professional services.
* Knowledge of CMS Guidelines including but not limited to NCCI policy manuals, LCD/NCD policies etc.
* Possess basic PC skills, including ability to work with MS Word and Excel.
* Thoroughness and attention to detail.

Environmental Factors

Occasional exposure to moderate environmental variations, above-normal noise levels, and/or unpleasant substances. Exposure to hazardous or potentially injurious elements or conditions is limited.

Physical Demands

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job.

* Extensive use of keyboard, monitor and mouse.
* Occasional business-related travel might be required.
* Little or no physical effort or strenuous activity other than incidental walking, standing, bending and reaching and carrying of light loads (1 to 5 pounds).

Mental Demands

* Analyze information or data.
* Ability to adjust to performing routine and repetitive tasks without specific supervision.
* Ability to understand and relate to the concepts behind specific ideas and remember multiple tasks given to self and others over long periods of time.
* Comprehend written basic instructions, and office memoranda.
* Ability to adhere to strict confidentiality requirements.
* Ability to communicate in oral and written form using high level of vocabulary.

Responsibilities

* Identifies and assigns appropriate codes for the purpose of reimbursement, research, and compliance in accordance with ICD-10 and CPT coding guidelines.
* Reviews all professional services encounters and assigns and sequences all diagnoses and procedure codes to the highest level of specificity documented in the provider notes.
* Accurately assign Evaluation & Management ("E/M") services after review of the provider's documentation in accordance with the 1995 or 1997 E/M documentation guidelines.
* Assign ICD-10-CM, CPT / HCPCS coding and modifiers for professional services.
* Complies with all federal, local and other legal requirements as they relate to medical coding practices.
* Observes confidentiality and safeguards all patient related information.

* Follow CMS Guidance including but not limited to NCCI policy manuals, LCD / NCD policies etc.
* Understand and follow DMG specific coding requirements.
* Complete coding tasks while maintaining the required accuracy and productivity standards.
* Utilize DMMG's Epic electronic health record ("EHR") and other DMMG and DMH documentation and billing systems to abstract and code all professional services, including data entry of codes.
* Use professional services encoder software to determine RVU values for correct coding assignment and modifier use.
* Participate in DMMG's coding quality reviews as deemed appropriate by the HIM Director.
* Attend continuing education classes to maintain coding credential and continually improve proficiency in areas of coding that include but are not limited to CPT, ambulatory surgery, surgical specialties, E/M assignment, ICD-10-CM and other specialties as required.
* Interpret coding rules and general policies in addition to determining appropriate conclusions.
* Complete administrative activities such as time reporting, productivity reporting and expense reporting as necessary and in accordance with established policies and deadlines.
* Communicates in a positive and professional manner with visitors, physicians, and hospital staff.
* Perform other job-related duties as required.

Keywords: Taylorville Memorial Hospital, Decatur , Professional Services Coder III, Other , Decatur, Illinois