Physician Medical Coding Specialist I

GENESIS HEALTHCARE SYSTEM

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an 'owner' of Genesis and keep our patients at the center of everything we do - always.

Position Details:

Work Shift:
Varied Shift (United States of America)

Scheduled Weekly Hours:
40

Department:
Physician Coding

Overview of Position:

Works day-to-day on assigned charge review WQ's to review Physicians, Nurse Practitioners and Physician Assistants documentation thoroughly, assigns the appropriate Evaluation and Management code, CPT procedure codes, HCPCS procedure codes, modifiers, and ICD-10 diagnosis code(s) to ensure optimal, correct, and timely coding. Codes medical claims per documentation, daily reconciliation and investigating and resolving denials.
ESSENTIAL DUTIES
1. Adheres to the ICD-10-CM coding conventions, official coding guidelines, CPT rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets.
2. Reviews and applies coding and reimbursement resources in a timely manner to ensure an up-to-date knowledge base.
3. Assigns and reports codes that are clearly and consistently supported by provider documentation in the electronic health record.
4. Discerns clinical notes, uses skills, and knowledge of currently mandated coding and classification systems, and office resources to select the appropriate diagnostic and procedural codes.
5. Responsible for working assigned Charge Review WQ's daily and maintain average aging day expectation.
6. Responsible for working assigned denials daily and applying knowledge from denials to day-to-day coding work.
7. Responsible for reconciling hospital rounding/surgical charges to ensure all revenue is being captured daily.
8. Collaborates with the physician coding auditor and educator on educating providers and other clinicians by advocating proper documentation practices, further specificity and re-sequencing or inclusion of diagnoses or procedures to more accurately reflect the acuity, severity and occurrence of events.
9. Actively participates in new provider coding and documentation education and in collaboration with the physician coding auditor and educator.
10. Queries providers for clarification/additional documentation prior to code assignment when there is conflicting or ambiguous data in the electronic health record.
11. Ensures accurate, complete, and consistent coding practices for the production of quality healthcare data.
12. Consistently applies and optimizes coding based upon compliant reimbursement guidelines.
13. Identifies and reports inappropriate coding practices.
14. Routinely abstracts clinical information from the medical record according to department procedure.
15. Assists in training of other staff in computer applications and department procedures.
16. Establishes report parameters to produce meaningful data.
17. Verifies patient identity to ensure correct filing of patient information.
18. Adheres to the Physician Coding and Education Quality Assurance policy and procedure.
19. Adheres to the Physician Coding and Education Productivity Measures policy and procedure.
20. Adheres to the Physician Coding Code Change policy and procedure.
21. Adheres to the Physician Coding Query Escalation policy and procedure.
22. Adheres to the Physician Billing and Coding Denial Escalation policy and procedure.
23. Adheres to the Physician Billing and Coding Rebill policy and procedure.

QUALIFICATIONS
1. High School diploma or GED required.
2. Minimum of one (1) year experience working in the Physician based coding field or must be certified in one of the following: CPC, CCS-P, or RHIT (or related certification), or must obtain within 12 months from date of hire.
3. Knowledge of medical terminology and anatomy and physiology.
4. Demonstrates understanding of various coding and reimbursement systems, including ICD-10-CM, CPT and HCPCS required.
5. Ability to analyze and interpret clinical data.
6. Demonstrates critical thinking skills to make appropriate interventions.
7. Excellent verbal and written communication skills.
8. Demonstrates data entry skills, with knowledge of various software applications, including Microsoft Excel, Word, and Power Point.
9. Knowledge of EPIC electronic medical record and 3M encoder preferred, but not required.
10. Ability to work independently.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values:
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role...connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
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.

1. Ability to work independently and multi-task.
2. Ability to sit up to 8 hours.
3. Ability to maintain concentration during times of frequent interruptions.
4. Ability to read handwritten and printer material, and computer monitor.
5. Ability to tolerate stress related to the mental and physical demands of the position.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.