: The Professional Fee Coding Specialist II at St. Charles Health System is responsible for coding and charging SCMG Clinical Services as well as resolving billing edits and denials. This position does not directly manage other caregivers, however, may be asked to review and provide feedback on the work of other caregivers.
Essential Functions And DutiesAdvanced skills in reading and interpreting documents contained in the medical record to identify and code all relevant ICD–10-CM diagnoses and CPT-4 procedures for professional fee charges by utilizing an encoder program, and following National and SCHS coding guidelines, Coding Clinic, CPT-4 and other appropriate coding references and tools to ensure proper code assignment and modifiers.
Abstracts medical record information in compliance with CMS requirements and SCHS abstracting procedures as appropriate. Use available tools to check entries for accuracy. This may include data for clinical studies and quality management activities.
Captures the correct modifiers appropriate for CPT code assignment.
Reconciles CCI and Medical Necessity edits.
Maintains productivity and quality standards.
Works closely with the Patient Financial Services department on medical necessity issues, claim denials, charge master issues, and charge auditor issues.
Supports the vision, mission, and values of the organization in all respects.
Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
Provides and maintains a safe environment for caregivers, patients, and guests.
Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.
May perform additional duties of similar complexity within the organization, as required or assigned.
EducationRequired: High School diploma or GED required. Graduate of an AHIMA Accredited Health Information Technology program or certification in a self-study course from AHIMA or AAPC required.
Preferred: N/A
Licensure/Certification/RegistrationRequired: Must possess a valid Registered Health Information Technician (RHIT) certification or one or more of the following: RHIA, CCA, CCS, CCS-P, CPC, COC, CPC-H. This position will require the caregiver to maintain required educational credits (CE) through AHIMA or AAPC.
Preferred: Risk Adjustment Coding (micro credential) or AAPCs Certified Adjustment Coder (CRC). Maintains required education credits (CE) through AHIMA and/or AAPC.
ExperienceRequired: Minimum of one year of hospital or professional coding experience with a Health Information Management focus.
Preferred: Familiarity with 3M encoder.