Reviews and assures that all services documented in the patient’s charts are coded with appropriate CPT, HCPCS and ICD codes.
Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 44 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 78 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
Summary: Reviews and assures that all services documented in the patient’s charts are coded with appropriate CPT, HCPCS and ICD codes.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Evaluates medical record documentation to ensure appropriate assignment and sequencing of the correct diagnostic and procedure codes for services and treatments as documented in health records.
- Provides training, mentoring and direction to medical coding staff in the department.
- Works with clinics to resolve denials from the clinic denial logs.
- Requests additional medical records as needed to clarify missing or inadequate medical record information required to complete the coding assessment and adhere to documentation and billing requirements.
- Makes corrections as needed to ensure accurate coding and billing and reimbursement processing.
- Communicates coding results to the appropriate staff for data entry.
- Maintains a working knowledge of CPT, HCPCS and ICD coding principles, governmental regulations, protocols and third party requirements regarding billing and documentation.
- Remains current on all changes in legislative regulations that impact coding.
- Reports noncompliance issues detected through auditing and monitoring to the department supervisor and the Senior Director of Physician Coding and Documentation.
- Ensures assigned projects are completed in a timely manner
- Maintains strict confidentiality of provider information, patient data, financial and billing information
- Reports noncompliance issues detected through to the department Manager and Senior Director
- Complies with all policies and procedures of the Corporate Compliance Program
- Attends meetings as requested, which may necessitate working in the evening or very early morning
- Assists with special projects as assigned by the Senior Director of Physician Coding, Documentation and Compliance and supervisor
- Work with other staff members to inspire teamwork and promote cooperation.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Fluent in the English language
- Possess a vast knowledge of CPT, ICD and HCPCS coding and reimbursement issues for physician offices and clinics
- Strong knowledge of 1995 and 1997 Documentation guidelines
- Excellent understanding and comprehension of medical terminology
- Must have the ability to balance and juggle multiple tasks, projects and requests
- Must be able to make sound decisions objectively and follow through
- Ability to communicate effectively any issues or weaknesses with coding and documentation to the providers
- Must be detail oriented and analytical
- Able to interact confidently with providers, staff, corporate CHS management and/or other CHS affiliated personnel
- Normal visual and auditory activity is required
- Emotional and mental stability required to deal with periods of high stress
- Possess clinical knowledge and ability to evaluate and summarize clinical records to support successful appeal
- Proven analytical and organizational ability.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software; practice management software and electronic medical records software.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to sit for prolonged periods of time, work on keyboard and view monitor for majority of the work day..
Certificates and Licenses:
CPC or CCS-P
High School Diploma and/or GED
Minimum of 5 years experience working with physician offices or clinics working with diagnostic and procedure coding and/or medical billing