Job Description

POSITION SUMMARY:

The Physician Practice Coder position is responsible for accurate and compliant coding of surgical cases for multiple specialties across all care settings. This position directly impacts revenue integrity by ensuring optimal CPT / ICD-10-CM / HCPCS II coding and appropriate modifiers, along with minimizing payer front end rejections and denials. The Physician Practice Coder is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician coding and billing.

Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.

Position: Coder-Surgical

Department: BUMG Corporate PBO General

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

· Perform coding and related duties of moderate and high complexity surgical cases, and Evaluation and Management services, using established guidelines in an accurate and timely manner.

· Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements.

· Research billing rules and regulations for new and existing procedures.

· Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report potential coding problems.

· Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, workshops, review of current literature and other educational programs.

· Resolves coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.

· Provide cross coverage of multiple specialties.

· Function as a resource to external customers. Research and resolve coding questions/inquiries. Make recommendations for coding policy changes.

· Functions as subject matter expert for assigned specialties.

· Develop and maintain division specific coding procedures and/or billing area instructions.

· Complete special projects and other duties as assigned by manager.

· Participate in coding education for providers and co-workers upon request.

· Maintain coding certification.

· Sequence diagnoses, procedures and modifiers by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.

· Maintains productivity standards set forth in Departmental Policies and procedures.

· Ensure billed service is being accurately coded.

· Must adhere to all of BMC’s RESPECT behavioral standards.

· Ability to work in face-paced, results driven position

JOB REQUIREMENTS

EDUCATION:

· Associates Degree (or direct work experience equivalent to at least 3 years).

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

· Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CANPC, CGSC, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA

EXPERIENCE:

· Minimum of 3 years’ experience conducting surgical coding/auditing in a surgical environment to include compliance, and billing processes.

KNOWLEDGE AND SKILLS:

· Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.

· Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.

· Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.

· Able to correctly code moderate/high complexity work.

· Understands, retains, and is able to research coding billing rules, regulations, and requirements.

· Deep knowledge of NCCI edits and bundling rules

· Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.

· Able to share/transfer knowledge or train co-workers, peers, billing managers on coding - Able to provide education with physicians in small group or one-on-one sessions as needed or requested.

· Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.

· Able to provide cross-coverage of multiple specialties.

· Proficient with computer applications (MS Office etc.), Excellent data entry skills.

· Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.

· Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.

· Ability to work with accuracy and attention to detail.

· Ability to solve problems appropriately using job knowledge and current policies/procedures.

· Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.

· Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations

Compensation Range:

$24.04- $33.65

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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