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Job Summary: The Pro Fee Coding Specialist performs diagnosis and/or procedural coding as assigned in order to apply the appropriate diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing.
Minimum Education: Commensurate education with achieving qualifications to sit for Certification Exam(s) as related to ICD-10, CPT and other related specialty certifications.
Licensure, Registration and/or Certification: Certified Coder through AAPC, AHIMA, BCHH-C, HCCS for Home Health or National Healthcare Association. Applicants who have not yet achieved a coding certification may be considered when work experience is at least two years. The applicant will need to obtain the certification within one year of hire.
Work Experience: 0 - 2 years related experience including a demonstrated thorough understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. Requires experience and/or training in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.
Knowledge, Skills and Abilities: Basic computer and encoder skills. Effective interpersonal, oral and written communication skills. Ability to organize and prioritize work in an efficient and effective manner. Uses good judgment when determining whether a record is complete enough to code or should be held for more documentation. Ability and requires maintaining continuing education credits for credentialed coders, stays updated on coding rules, attends seminars and reviews and coding periodicals. Ability to be cooperative, dependable and responsive to the changing nature of the coding workflow. Ability to be flexible when asked to do different assignments.
Essential Functions and Responsibilities: Codes as assigned from review of medical record documentation. Applies knowledge of current coding and billing requirements to assure claims are submitted correctly. Monitors coding and billing performance and resolves denials related to coding errors. Performs review for charge corrections and rebilling as required for resolution of coding denials. Develops preventative measures in response to patterns identified through analysis of claims denial data; prepares periodic reports for clinical staff, identifying corrective measures to resolve denial problems. Advises and instructs providers regarding documentation and billing policies, procedures and regulations; interacts with providers regarding conflicting, ambiguous or none-specific documentation, obtaining clarification of same. Educates provides and office staff regarding documentation coding and billing changes and regulations to assure compliance with local, state and national policies. Works collaboratively with providers, office staff, billing personnel, quality department and compliance, and coding resources to ensure accurate coding.
Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field.
Working Relationships: Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff.
Special Job Dimensions: None.
Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Health Information Ambulatory Coding - Yale Campus
