Join our Mercyhealth Professional Coding team!
The purpose of the Medical Coding Specialist 2 is to review assigned physicians’ procedure (CPT) and diagnosis (ICD-10) codes, and make coding changes as necessary. Providing timely feedback to providers regarding documentation guidelines, diagnosis coding and procedure coding. Performs other duties as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Reviews, analyzes, and interprets physician documentation with regards to procedure and diagnosis code selection.
- Identifies discrepancies between the physician code selection and the medical record documentation; corrects them, and presents findings and education to the appropriate physician.
- Performs scheduled audits of physician coding and documentation to make recommendations for improvements and enhancements.
- Maintains a close working relationship with assigned physicians and medical office, frequently querying the physician when coding discrepancies arise.
- Researches any coding questions the physician or medical staff may have, and presents findings to them.
- Codes hospital cases by reviewing the procedure reports, other documentation, and the assignment of diagnosis and procedure codes, releasing charges within the Epic system.
- Demonstrates a high skill level in correlating generalized observations/symptoms to a stated diagnosis to assign the correct ICD-10 code.
- Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA) and the Center for Medicare & Medicaid Services (CMS) with regards to the assignment of ICD-10, CPT, and HCPCS codes, including knowledge of the 95/97 Evaluation & Management billing guidelines.
- Has a thorough understanding of the differences between professional coding in a clinic setting as compared to professional coding in a hospital setting (outpatient and inpatient), and demonstrates a high skill level in the practical application of that knowledge.
- Reviews Advanced Beneficiary Notices (ABNs) and confirms that the form is valid with regards to the information entered on it. Provides education to the appropriate medical office when discrepancies are identified.
- Reviews encounter forms, identifies any issues with the forms, and corrects them before posting charges.
- Works with Business Office staff in developing efficient coding processes and researching denials.
- Maintains an in-depth knowledge of Epic ambulatory and hospital modules.
- Stays current regarding knowledge of updated regulations, laws, and new procedures.
- Assists with all coding functions at or above the level of a Medical Coding I job summary.
- Maintains patient confidentiality.
- Attends all mandatory in-services and department meetings.
- Maintains a professional appearance and encourages behavior appropriate for a healthcare setting.
- Consistently demonstrates a self-directed, mature, disciplined and tactful approach to completing work duties.
- Provides spontaneous and accurate responses.
- On occasion, with the coordination of the supervisor adjusts workload.
- Understands and applies the Team Concept.
CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS
To perform the job successfully, an individual should demonstrate the following behavior expectations:
Quality- Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.
Service- Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.
Partnering- Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.
Cost- Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.
EDUCATION & EXPERIENCE
Certified in professional coding (currently holds either CPC, CPC-H, CCA, or CCS-P credential)
Graduate of high school or equivalent
Prefer two years of experience coding professional charges in an outpatient or clinic setting.
Medical Terminology knowledge is required
Passing the Driver's License Check and/or Credit Check (for those positions requiring).
Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.
Must be able to follow written/oral instructions.
To perform this job successfully, an individual should have knowledge of Accounts Receivable Systems software, payer sites for claims and authorization statuses, eligibility software, and Microsoft Office Suite (primarily Word and Excel). Must be able to multitask and toggle between screens, document different systems timely, thoroughly, and efficiently.
OTHER SKILLS AND ABILITIES
Problem solving skills
Excellent written/oral/interpersonal/communication skills
Calculator and computer skills
Knowledge of all business office software a plus
May be required to work weekends, holidays and reasonable amounts over overtime when necessary.
The noise level in the work environment is usually very quiet.
Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.
AGE OF PATIENTS SERVED
Neonate (birth – 28 days)
Infant (29 days – less than 1 year)
Pediatric (1 year – 12 years)
Adolescents (13 years – 17 years)
Adult (18 years – 64 years)
Geriatric (65 years and older)
Partner may access patient care information needed to perform their duties.
WORK CONTACT GROUP
Physicians, nurses, medical records and other billing department staff.
SPECIAL PHYSICAL DEMANDS
The Special Physical Demands are considered Essential Job Function of the position with or without accommodations
While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl. The employee is frequently required to sit and work at a computer for long periods of time up to 10 hours daily. The employee is occasionally required to stand for long periods of time. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. The employee must be able to hear at high and low levels through voice and telephone communications to be able to respond to patients and partners.
While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard. Requires exerting 25 to 50 pounds of force occasionally, and lift up to 10 to 15 pounds frequently.
LEVEL OF SUPERVISION
Work is performed according to detailed, specific instructions based on volume.
This job has no supervisory responsibilities.
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