Job Description

Specific Duties & Responsibilities



Procedural Knowledge

Responsible for all abstract coding from the surgical operative/procedure note and applying all CPT/ASA codes and modifiers in compliance with CMS coding guidelines.
Works closely with departmental manager, supervisor and various Coding Specialist IIIs to ensure coding is accurate.
Serves as departmental expert on coding questions to other staff inquiries
Exercises independent judgment and decision making on a regular basis with respect to code selection.
Holds cases and seeks corrective action for services not meeting documentation requirements in accordance with Department policies.
Research and answer billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
Review and resolve Epic Charge Review edits daily.


Professional & Personal Development

Participate in on-going educational activities.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.


Service Excellence

Must adhere to Service Excellence Standards.
Customer Relations.
Self-Management.
Teamwork.
Communications.
Ownership/Accountability.
Continuous Performance Improvement.


Minimum Qualifications
High School Diploma/GED required.
Medical Terminology, Anatomy and Physiology courses or demonstrated appropriate knowledge.
CPC Certification (or department approved certification).
Three years coding experience with demonstrated analytical skills.
Experience with Medicare regulations.
Epic experience and understanding of third-party payer issues