Professional Coder III, PB Coding

Overview

Professional Coder III, PB Coding

40 hours per week, day shift

JOB SUMMARY:  Under limited supervision, abstracts and codes hospital based, inpatient hospital, outpatient and ambulatory physician (and mid-level provider) services and special procedures (e.g., Emergency Room, Ambulatory Surgery, Day Hospital, Sticht Center, Forsyth Hospital).  Uses standard ICD diagnosis and CPT professional coding guidelines, Medicare, Medicaid and other third party regulations/requirements, as well as internal coding guidelines, in order to provide data for billing and reimbursement. This classification is intended for the most highly experienced and competent coding personnel.

EDUCATION/EXPERIENCE:  Graduation from an accredited medical coding program and three years of medical coding experience in a similar environment.

LICENSURE, CERTIFICATION, and/or REGISTRATION:  National coding certification (CPC or CCS).

ESSENTIAL FUNCTIONS:

1.            Responsible for timely and accurate coding of hospital based professional services (outpatient hospital or inpatient hospital; single services or complete inpatient stays) by reading medical record documentation  to assign and  sequence diagnoses and procedure codes  according to coding guidelines, and enter into the electronic system:

    a.  Appropriate diagnoses codes, professional service codes and modifiers and/or facility service codes.

    b.  Assign and record appropriate modifiers (i.e., GC, NO or NDU) as appropriate based on Teaching Physician rules.

2.            Maintains a current knowledge of ICD diagnosis codes, CPT physician service codes, internal codes (for unlisted or unusual CPT codes), and governmental (Medicare, Medicaid, TriCare), commercial and managed care regulations by reading relevant professional literature and by attending workshops and lectures.

3.            Accrues sufficient continuing education hours to maintain national coding certification.

4.            Serves as a resource for less experienced medical coders.

5.            Works collaboratively with team members, Corporate Revenue Cycle and Compliance Analysts to answer questions and/or resolve issues related to documentation, coding and billing of professional services and/or facility services. 

6.            Provides physician education to ensure documentation is sufficient for greatest accuracy of coding.

7.            Resolves pending charges in the WakeOne coding work queues including claim denial work queues.

8.            Responsible for researching specific questions/issues or conducting special projects as assigned.

9.            Serves as a resource and/or participate in quality control functions such as assisting in audits of the departmental coding section.

10.          Performs other related duties incidental to the work described herein.

SKILLS/QUALIFICATIONS:

• Experience in coding of physician professional services in a teaching environment
• Familiarity with Medicare Teaching Physician Rules
• Familiarity with facility fee services within a Provider Based clinic
• Ability to meet and maintain performance standards of quality and productivity for Level III Coder by department
• Good oral communication skills
• Ability to provide guidance to others (if applicable)

WORK ENVIRONMENT:

• Clean, well-lit and comfortable environment
• Quiet work area

PHYSICAL REQUIREMENTS:

0%          35%        65%                       

to            to            to                           

35%        65%        100%     N/A        Activity

X                                                             Standing

X                                                             Walking

                                X                             Sitting

X                                                             Bending

                                X                             Reaching with arms

                                X                             Finger and hand dexterity

                                X                             Talking

                                X                             Hearing

                                X                             Seeing

                                                                Lifting, carrying, pushing and or pulling:

X                                                             20 lbs. maximum

X                                                             50 lbs. maximum

X                                                             100 lbs. maximum