Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Physician Financial Services

Job Family

Professional

Work Shift

Days (United States of America)

Summary

Thoroughly review medical records to code specifically and accurately those conditions or diagnoses that were treated or affected the patient's plan of care. Verify that each medical record reviewed contains appropriate documentation to justify the selected CPT, HCPCS, modifiers and ICD-10 codes. Work with Physician Billing Office and physician practices to improve code assignment, resolve and prevent edits and review for documentation deficiencies. Help educate and develop professional coding within the CFV Medical Group and Physician Business Office.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Work closely with CFV Medical Group/Ambulatory practices and Physician Revenue Cycle/Business Office to ensure CPT, ICD-10 and modifier usage is accurate on claims

• Assist in overall goal to reduce coding related denials and improve coding related editing

• Assist and advise Business Office on coding related denials by reviewing medical record documentation to make corrections and/or adjustments to claims as needed

• Assess NCCI and CCI edits as necessary to apply appropriate modifiers and work closely with Business Office to improve front end editing as needed

• Assist in identifying revenue opportunities within the Medical Group through the creation of Job Aids and instructional/educational materials

• Provide education and feedback to providers, coding staff and billing staff as needed to ensure documentation requirements are maintained and revenue is optimized

• Analyze providers’ coding profiles (E/M coding distribution) and documentation patterns to ensure that providers are confident with code selection and documentation requirements

• Support the development of professional coders and coding standards within the Medical Group and Business Office

• Coordinate with Revenue Integrity on identifying documentation gaps, potential revenue opportunities and support documentation improvement efforts overall

• Make management team aware of problem issues, negative physician communication and/or other influences that impact effectiveness of job performance

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school diploma or equivalent required

• Certified Coding Specialist (CCS) credential required

• Obtain Certified Professional Coder or other equivalent coding credential (such as CCS-P) within 1 year of employment required

Work Experience: 

• 1 year ICD-10 and CPT-4 coding experience in a hospital setting required

• 2 years professional revenue cycle experience required

• 1 year experience in Business Office, physician practice or professional coding environment preferred

Knowledge, Skills, and Abilities Required: 

• Proficiency in reading, writing, and speaking the English language

• Knowledge of ICD-10-CM/PCS and CPT 4 coding

• Knowledge of anatomy and physiology, medical terminology and the various medical specialties as required to accurately code all different types of medical records

• Use tact and diplomacy in all communications with physicians and other CFVH personnel

• Ability to effectively coordinate staff training and continuing education

• Ability to work well independently

• Ability to problem solve

• Excellent written and oral communication skills

• Knowledge of medical necessity guidelines and recognition of the impact on coding accuracy and appropriate hospital reimbursement

Physical Requirements: 

• Computer literate

• Speech, sight and hearing required as incumbent must work independently in effectively training and monitoring coding functions

• Long periods of sitting

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity