Outpatient Physician Coding Specialist

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Shift

Monday - Friday, Days

Scheduled Weekly Hours

40

POSITION PURPOSE:         

Perform Prospective and Retrospective coding / compliance reviews of surgical procedure documentation supporting codes assigned by practitioners.  Perform audits on physician E/M coding against documentation in the medical record.  Meet with physicians and other clinical staff on a regular basis and provide training and education.  Research and review Insurance claims denied due to Coding-related issues.  Maintains knowledge of federal regulations related to physician coding and reimbursement.  Complete coding tasks as needed for the completion of sending clean claims to payers.  Assist with monitoring and reviews to ensure coding accuracy and compliance.

ESSENTIAL FUNCTIONS:

• Performs Prospective and Retrospective coding reviews of surgical procedure documentation supporting codes assigned by practitioners, checking for coding accuracy including procedure and diagnosis codes, correct place of service, appropriate modifiers, etc.
• Demonstrate the ability to independently comprehend the clinical content of a medical record and be able to properly sequence the codes.
• Perform audits on practitioner E/M coding against documentation in the medical record and confirm the appropriate charge level.
• Meet with new physicians who have just started here to assess the practitioner’s level of coding knowledge.  Educate the practitioner on Clinic coding guidelines, workflow, software functionality, etc.
• Meet with physicians and other clinical staff on a regular basis and provide training and education.  Follow up on all issues and problems that they may be having and suggest changes for improvement.
• Reviews Commercial claims that do not pass the Claim scrubber audit.  Reviews the claim and determines the problem and makes corrections as necessary.
• Researches insurance and government payor claim denials due to Coding issues.  Make corrections or appeals as necessary for claim resubmission.
• Review patient complaints that come from the Business Office due to Coding issues.  Make corrections or appeals as necessary for claim resubmission.
• Identify coding issues that should be logged on the Compliance Audit report.  Provide necessary training and education to clinical staff to fix the issue.  Complete a follow up review at a later date to make sure the problem is still resolved.
• Perform 24/72 hour rule checks each day.  Complete facility fee posting. Prepare claims for Medicare Part A submission.
• Processes all hospital charges for fee for time (locum tenens) physicians coding CPT and ICD-10 codes, creating appointments and route sheets.
• Processes all Cardiology special procedure and Vascular surgery charges.
• Maintain knowledge of Federal regulations related to physician coding and reimbursement.  Attend webinars, read bulletins, and participate in Coding group meetings as directed by Coding Manager.  Maintain coding credentials through Coding society.
• Complete other tasks as assigned by Coding Manager.

SPECIALIZED KNOW-HOW & REQUIREMENTS:

• 2 years of experience working in a medical center doing billing, coding, or reimbursement with Medicare, Medicaid and insurance required.
• CPC, CCA, CCS, CCS-P, RHIA or RHIT preferred
• CPC must be successfully completed within 2 years of hire.
• Working knowledge of medical billing regulatory requirements, understanding of CPT and ICD-9 diagnosis coding, modifiers, etc. preferred.
• Computer literacy including operation and software application use required.

Compensation Range

$19.40 - $29.10

Available Benefits for Benefit Eligible Positions

Health and Dental Insurance

IMRF (Illinois Municipal Retirement Fund)

Retirement Fund (457 and 401A Plan)

Medical and Dependent Care Flexible Spending

Life Insurance

Short and Long Term Disability

Optional Insurances

Paid Time Off

Tuition Reimbursement and Loan Forgiveness

Gift Shop Discount

CGH Day Care Discount

CGH Dietary Discount

Employee Assistance Program

CGH Pharmacy Discount

CGH Vision Center Discount

Thank you for your interest in a career at CGH Medical Center.