Pro Fee Coding Specialist

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Job Summary: The Pro Fee Coding Specialist reviews documentation and reviews, adds or corrects diagnosis and procedure codes that have been submitted by the provider. This role utilizes coding knowledge learned through valid coding resources in decision making.

Minimum Education: GED or High School diploma.

Licensure, Registration and/or Certification: (CCS) Certified Coding Specialist - American Health Information Management Association (AHIMA), (CPC) Certified Professional Coder - American Association of Professional Coders (AAPC), (BCHH-C) Board Certified Home Health Coding Credentialing – WellSky, (RHIA) Registered Health Information Administrator - American Health Information Management Association (AHIMA), (RHIT) Registered Health Information Technician - American Health Information Management Association (AHIMA), or Hierarchical Conditions Categories (HCCS) from The Compliance Certification Board (CCB). The applicant will need to obtain the certification within one year of hire if they do not have a required certification.

Work Experience: None. 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, preferred. 2 years related experience, preferred.

Knowledge, Skills, and Abilities: Sound knowledge and understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. Basic encoder skills. Knowledge of Microsoft 365 and other applicable software. Excellent communication skills, both written and verbal that present clear and concise information. Effective interpersonal, organizational, and multitasking skills. Ability to determine whether a record is complete enough to code or should be held for more documentation. Sound ability to be cooperative, dependable and responsive to the changing nature of the coding workflow. Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines.

Essential Functions and Responsibilities: Codes as assigned from review of medical record documentation. Applies knowledge of current coding and billing requirements to ensure 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 the same. Educates providers 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. Stays updated on coding rules, attends seminars and reviews and coding periodicals.

Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field.

Working Relationships: Works directly with patients and/or customers. Works with internal and/or external 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.

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