Job Description

Job Category:

Revenue Cycle

Work Shift/Schedule:

Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

This is an Advanced Level III position in which the employee has demonstrated an advanced knowledge of ICD-10 CM-PCS and CPT coding guidelines and is fully competent to independently code the most complex inpatient and or outpatient service types and resolve any associated edits. Responsible for responding to coding related questions from other departments and for assisting in reviewing and responding to denials. May be called upon to represent coding in meetings.

Minimum Job Qualifications

• Licensure or other certifications: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

• Educational Requirements: High School Diploma or GED. Must pass an advanced coder competency exam with a minimum score of 95% demonstrating proficiency in inpatient and/or outpatient coding of all service types or pass and earn the CCS certification while in the Coder HIM II job title.

• Minimum Experience: Five (5) years of hospital based coding experience to include complex CPT surgical coding and advanced ICD-10-CM-PCS coding.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: Certified Coding Specialist (CCS)

• Preferred Educational Requirements:

• Preferred Experience: Seven (7) years or more years of hospital-based coding experience to include complex CPT surgical coding and advanced ICD-10-CM-PCS coding. Experience in Teaching and/or Trauma 1 Facilities.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Proficiency of 95% or greater on coding audit reviews, must be maintained for two consecutive quarters for inpatient and/or outpatient coding of all service types

• Advanced knowledge of anatomy & physiology, disease processes, medical terminology, pharmacology, and surgical procedures/techniques

• Ability to multitask, prioritize, and manage time efficiently

• Must possess a high level of accuracy and attention to detail

• Proficient use of electronic health records (EPIC) and encoder systems (3M)

• Proficient in the use of Microsoft Word and Excel. Knowledge of Microsoft PowerPoint

• Ability to work independently as a remote employee while remaining actively engaged and supportive of the coding team as a whole

• Effective written and verbal communication skills

• Advanced knowledge of Coding resources and demonstrated proficiency in using the appropriate resources

• Advanced knowledge of billing requirements and the ability to resolve the most complex edits

Essential Tasks and Responsibilities

• Reviews work queue assignments and prioritizes work by date, charges and payors to meet revenue cycle goals.

• Assigns and sequences diagnosis and procedure codes using appropriate classification systems and official coding guidelines to insure that DRG (Diagnosis-related group) or APC (Ambulatory Payment Classification) assignment is correct. Codes inpatient (IP), same day surgery (SDC), observation (OBS), emergency department (ED), recurring (RCR), and clinical (CLI) records, including the assignment of ICD-10-CM, Procedure Categories, modifiers (when applicable) and HCPCS/CPT codes across multiple facilities and possible E/M levels.

• Reviews documentation and possibly charges to correctly assign outpatient procedure codes (ED Only).

• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.

• Initiates physician query in compliance with Company policy when appropriate.

• Reassign accounts with missing or incomplete documentation/charges to appropriate work queues.

• Correctly abstracts discharge disposition, performing physician, and procedure dates. Corrects discharge disposition based on payer requirements.

• In- depth knowledge of coding and charging requirements necessary to resolve billing edits at time of coding.

• Works with revenue cycle to resolve issues related to billing.

• Ability to audit coding quality and provide feedback on an as needed basis.

• As a remote employee must be able to organize work to ensure goals are met. Identifies and escalates any obstacles to fulfilling job responsibilities.

• Must maintain coding certification, continue to work towards knowledge base growth by cross-training to learn other patient types and attend in-service training as required.

• Attends and actively participates in huddles/meetings/committees as required and appropriate.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: % of time

• Kneeling/Stooping/Bending: O ccasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.