Each employee who participates in the coding, billing or claims submission process, from the initial receipt of a physician order to the receipt of payment for services, shall accurately and honestly perform his/her functions to ensure that accurate claims are submitted, and the organization retains only those funds to which it is legally entitled.
The PNS Coding Specialist I (CS I), will be responsible for accurately abstracting and assigning valid ICD, CPT codes to ensure appropriate reimbursement in accordance with federal and state regulatory guidance, for Provider Network Services. The CS I will determine the most appropriate diagnosis after a thorough review of the medical records and works closely with practice staff with regards to coding and assignment. The CS I will also review accounts to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission of billing for payment. The CS I will compare charges on accounts with the procedures coded and identifies and notifies Director any discrepancies. If an account is denied due to incorrect coding, the CS I will conduct medical records research and report finding to the Director of PNS Revenue Cycle. The CS I must be willing to report back to work during any emergency situation, this includes if needed during inclement weather, mass casualty, internal disaster, etc. The CS I will complete other duties as assigned.
All organizational staff, including this position are specifically required as a condition of continued employment to make advance preparations for their families and pets in the event of weather emergencies such as Hurricanes and flooding threats. Any staff member can be determined as essential staff required to report to the main facility during these events. In many cases this means reporting and sleeping at the facility before, during and after a weather emergency. By signing this job description, the staff member accepts this responsibility of readiness to report to work during any designated emergency staffing situation. CMC staff members operate as one team meeting the healthcare needs of our communities, thus this position will on occasion complete other duties as assigned beyond those designated in this primary job description which may include “float” coverage at an alternate facility, department or assignment.
- High school diploma required.
- 3 months previous billing/coding experience required.
- Previous experience in Physician reimbursement preferred.
- Previous experience using an electronic health record preferred.
- Certificate of Medical Coding completion from a Medical Coding program.
- AAPC Certification must be obtained within six (6) months of employment.
- Ability to work effectively and collaboratively with physicians, clinical and office staff personel and ancillary hospital departments required.
- Exemplary core customer service skills strongly required.
- Strong organizational skills required.
- Strong PC skills required.
- Strong verbal and written communication skills required.
- Exposure to or knowledge of encoding software and impact of coding and reimbursement assignments required.
- Stress level high due to multiple demands frequently occurring simultaneously.
- Physical surroundings pleasant and comfortable.
- Generally contained office type environment.
- Most work performed while sitting, however, a moderate amount of walking and moving around within a confined area occurs.
Light-Medium - While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Ability to hear to process instructions and safety code and alarms required. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and will be assessed by post offer Employee Health fit-for-duty review.