Coder II, Professional

Primarily focuses on coding of high complexity, such as surgical, specialty service, higher than average cost services, evaluation and management services. Responsible for resolving coding related denials.PRIMARY RESPONSIBILITIESManages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.

Identifies all billable services through review of all applicable data sources, including but not limited to: electronic health record, inpatient admit, discharge and transfer (ADT) reports, operative logs, nursing home visit documentation, procedure reports generated from non-the electronic health record systems, etc.

Reviews medical record documentation in the electronic health record and/or on paper. Identifies, enters and posts CPT-4 and ICD-10 codes to the electronic health record. Identifies need for medical records from outside the organization and follows established procedures to obtain. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.

Consults with physicians/ providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes. Provides education around documentation improvement for maximum patient care.

Assists physicians/providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to lead

Reviews and resolves charge sessions that fail charge review edits, claim edits, and follow up denials. Works to improve billing based on findings/resolution of errors.

Trains and mentors coding staff to effectively perform their job responsibilities following current coding policies and procedures. Assists coders with medical terminology, disease processes and complex surgical techniques.

Manages assigned charge review, claim edit, and coding follow up work ques.

Performs other duties as assigned.

EDUCATIONHigh school diploma or equivalent

EXPERIENCETwo years' experience

PHYSICAL REQUIREMENTSFrequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

Frequent keyboard use/data entry.

Occasional bending, stooping, kneeling, squatting, twisting and gripping.

Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

Rare climbing.

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