|Specialties:||E/M, Cardiology, Orthro, Inpatient, Outpatient, Radiology, Endo, Peds, OB
|Required Experience:||3 to 4 years
|Preferred Experience:||5 to 7 years
|Location:|| Chicago 600007, IL, US
R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1® is a publicly-traded organization with employees throughout the US and international locations.
Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
The Physician III Coder will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance).
Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting.
The successful candidate must have demonstrated proficiency in professional service vascular coding (95% accuracy) cases such as: AV Fistulas, Thromboendarterectomies, Carotid Stenting, Bypass Grafts, and AAA Repairs.
- Assigns codes for diagnoses, treatments and procedures according to the
- appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
- Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.
- Able to accurately abstract information from the medial records into the abstract system, according to established guidelines.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines
- Enters and validates codes, charges and other edits flagged in Athena or EPIC for review.
- Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units)
- Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity.
- Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.
- Meet and/or exceeds the established coding productivity standards
- Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards
- CCS-P, CPC
- Must be able to demonstrate proficiency in professional cardiovascular surgical services (95% accuracy).
- Minimum of 3 years professional coding experience in Cardiovascular Surgery
- Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (ie: Documentation Guidelines ’95 & ’97)
- Extensive knowledge of government, and commercial payer guidelines.
- Must be able to use standard office equipment and information systems.
- Must be able to travel to other sites for meetings and/or coder back-up.
- Ability to interact with other employees through effective communication.
- Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.