Ensures all technical aspects of the assignment of diagnostic and procedure coding is carried out in accordance with established standards and is in compliance with CMS, NCQA, third party payors, , other regulatory agencies and Kaiser Permanente policy.Functions includes, but are not limited to working charge review work queues for reimbursable accounts for all internal and external services, Assists supervisor in responding to coding questions from other levels of coders and in responding to providers. Conducts special projects and focused reviews of encounters as requested.
Essential Functions:
- Review and code services that are potentially reimbursable, including Medicare, Medicaid, Workers comp, and other third party payors by applying correct coding principles.
- Review and code ambulatory surgical services, and apply coding principles for correct coding.
- Respond to questions from providers through inbasket messages, coding hotline or in person as needed.
- Query providers for clarification of incomplete or ambiguous documentation as appropriate and monitor inbasket messages for timely responses.
- Identifies workflow issues and works with supervisor to address changes in process.
- Serves as a regional resource to other coders and healthcare professionals for documentation guidelines and proper ICD9, CPT and HCPCS level II Coding guidelines.
- Works in collaboration with Coding Supervisor, Revenue Integrity and Patient Financial Services to provide input on front and back end errors trends that impact Revenue Cycle Enhancement..
- Communicates and participates in local, regional, and operational strategic meetings and initiatives involving coding and the revenue cycle enhancement process.
- Participates in data quality and revenue cycle validation processes on a rotating basis.
- Performs other duties as assigned or required.
Qualifications:
Basic Qualifications:
- Four (4) years of experience in a health care setting is required.
- Three (3) years of coding experience is required.
- Two (2) years of medical terminology required.
- Three (3) years of customer service experience is required.
- Associates degree in health administration, RHIT certification or equivalent years of experience is required.
- CPC or CCS-P is required.
- CPC-H or CCS is required within six (6) months of employment.
- New Hire: Successful completion of Assessment of Critical Coding Skills, 80% or higher passing score.
- Annually: Successful completion of Assessment of Critical Coding Skills, 80% or higher passing score.
- Three (3) years of knowledge in coding practices is required.
- Three (3) years of knowledge of compliance and regulatory requirements is required.
- Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data is required.
- Effective verbal and written communication skills, as well as, strong interpersonal skills is required.
- Ability to effectively abstract medical information to determine the correct data is required.
- Strong data management skills including proficiency in MS Office applications is required.
- Ability to work independently with minimal supervision is required.
Preferred Qualifications:
- Project management experience preferred.
- Training/education experience preferred.
- Supervisory experience preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.