ATLANTICARE
_____________________________________________ROLE DESCRIPTION
|
TITLE: Professional Fee Coder |
|||
|
JOB CODE: 3293
|
EXEMPT: NON-EXEMPT: X
|
DATE: 03/24 |
REVISED:
|
|
Minimum Qualifications: |
|||
|
|||
POSITION SUMMARY
The role of the Professional Fee Coder – Level III is to interact extensively with the physician and other members of the healthcare team to facilitate the improvement in the overall quality, completeness and accuracy of medical record documentation. This will support the appropriate clinical picture and level of severity of the patient while providing accurate and complete information that is utilized in the medical record coding process to obtain appropriate reimbursement. The coder will identify opportunities for improvement in documentation to ensure accuracy of professional fee/physician services, E&M, CPT and HCPCS codes to ensure the submission of clean claims. This will be done in accordance with timely charging, billing and turnaround in system. They apply correct coding edits (NCCI, LCD, NCD and MUE) and payer-specific edits, correct modifiers and apply coding guidelines and accurate ICD-10-CM, CPT/HCPCS level II codes to patient encounter, while ensuring timely turnaround of charges. The Professional Fee Coder – Level III will demonstrate understanding of various system edits and the impact on reimbursement.
This position will also be responsible for coordinating and providing education to all physicians and other clinicians related to compliant documentation responsibilities and coding and abstraction issues. The coder will audit physician-assigned evaluation and management CPT codes for accuracy and documentation compliance. In addition, the coder will review coding denials and resolve issues in conjunction with the collections team.
This position will identify opportunities for documentation improvement to ensure accuracy and completeness of documentation used for measuring and reporting physician outcomes. The Professional Fee Coder – Level III will collaborate as necessary with other disciplines as necessary to communicate these opportunities for referral to the appropriate performance improvement committee for resolution.
This position will review both inpatient and outpatient hospital-based medical records using nationally recognized guidelines to ensure accurate and complete documentation of diagnoses, CPT procedures and HCPCS.
The Professional Fee Coder – Level III will demonstrate understanding of risk adjustment and clinical/medical complexity. The Coder, Outpatient – Level III will demonstrate understanding of various system edits and the impact on reimbursement.
QUALIFICATIONS
- EDUCATION: High school diploma required. Associate of Science degree in health information technology preferred. Bachelor of Science in HIM preferred. RHIA or RHIT preferred. Additional AAPC certifications preferred as applicable.
- LICENSE/CERTIFICATION: CPC required with minimum 5 years of recent hands-on E/M-level experience.
- Successful completion of a college-based coding program or college-based coding certificate program preferred (AHIMA-approved preferred).
- EXPERIENCE: Minimum 5 years of professional fee/physician services coding (recent hands-on production) experience required. Proficiency in clinical and business applications preferred at time of hire. Incumbents within position will be trained appropriately and then skill will be required for this position within 30–60 days from date of hire.
PERFORMANCE EXPECTATIONS
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.
WORK ENVIRONMENT
This active position requires the ability to work in a busy patient care area. Near visual acuity, long periods of visually examining documents and electronic files, and skilled use of multiple computer applications required. The health data integrity specialist works independently and autonomously with minimal supervision. Critical thinking and strong customer services skills required and ability to manage daily work duties accurately and efficiently.
The essential functions for this position are listed on the Assessment and Evaluation Tool.
REPORTING RELATIONSHIP
This position reports to department leadership.
The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
