Coding Specialist Sr. Clinic F/T Day

Prisma Health Greenville, SC
clinic billing compliance management procedures medical health icd-9 abstracts meetings departmental staff management manager

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Job Summary

Responsible for appropriate surgical & orthopedic coding of procedures using CPT-4 and ICD-9 codes. Obtains and reviews documentation for compliance and to ensure documentation supports the medical necessity for charges that are submitted for proper reimbursement. Maintains updated knowledge of coding/billing and reimbursement issues for multi-specialty medical practice. Updates physicians and staff regarding coding/reimbursement issues as needed. A minimum of 50% of the Coders time is devoted to coding medical services.

Accountabilities

  • Abstracts/codes all multi-specialty medical procedures and assigned evaluation and management services performed by physicians, assigning the appropriate CPT-4 and ICD-9 codes while utilizing the Correct Coding Initiative to ensure minimal coding errors and rejections. Conduct daily quality reviews and evaluations of coding accuracy and documentation requirements.Maintain coding and documentation compliance through the Documentation Compliance Process providing feedback to the physicians and residents to ensure correct coding and documentation compliance based on Medicare/Medicaid and Federal Teaching physician guidelines. 45%
  • Abstracts clinical and demographic information from the Life Time Clinical Record, OAS Gold, Net Access and IDX systems. Obtain clinical information from outside facilities for abstracting/coding purposes. Provides daily coding information/resolution to Physicians, Residents, Business Office Staff, Account Receivable Staff and Management on a daily basis. 13%
  • Participates in/conducts coding meetings and educational conferences in order to maintain coding accuracy and compliance with Physicians, Residents, Accounts Receivables staff and Management. 10%
  • Works with Central Billing Office and UMG Clinical Department practice staff as needed to resolve billing/coding problems related to documentation.5%
  • Assists with implementation/monitoring of Prisma Health Billing Compliance Plan and reimbursement process, as part of the Compliance Team. Analyzes claims rejections by carriers to improve and correct coding related reimbursement issues. Researches special requests of Clinical Department Chair,and/or Practice/Office Manager, practice staff and Central Billing Office/Operations Office Staff for reimbursement issues and compliance plan adherence. Works jointly with Quality AssuranceAnalystfor Quality Coding Reviewsand Compliance Audits. Follows guidelines for audits as found in the Prisma Health Billing Compliance Plan.10%
  • Maintains and enhances current knowledge of billing and coding practices at meetings and seminars, study of reference material and updates to coding manuals. Meets regularly with management and practice staff to discuss billing and reimbursement issues and changes for the purpose of improving departmental billing and reimbursement processes. Reviews newsletters, notices and updates to coding manuals to maintain current knowledge of applicable billing and coding practice and procedures. Make recommendations for change to departmental procedures in accordance with current practices and procedures. Attends meetings, conferences and seminars, as approved by department, to remain updated on latest billing procedures. Works jointly with Quality Assurance Analyst in training physicians, residents and departmental billing staff concerning billing/coding practices and procedures. Attends mandatory educational training sessions covering Prisma Health Compliance Policy guidelines on an annual/regular basis. Work will be reviewed to determine areas of deficiency and improvement. Establishes division of daily work within area of responsibility. Performs daily task in a timely fashion. Maintains daily log for management indicating work performance for multi-specialtypractice. 10%
  • Provides coverage as requested by management, during absences of staff to maintain department-billing/coding operations. Abstracts from medical records, prepares and codes fee tickets. May batch and enter fee ticket information into IDX system. May review Missing Charge Report and prepare fee tickets as necessary. May monitor and complete backlog for area of responsibility. 7%

Supervisory/Management Responsibilities

  • This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

  • Job related course work beyond High School-Required knowledge includes anatomy, physiology, medical terminology, ICD-9, CPT-4, and HCPCS coding. Working knowledge of reimbursement processes.
  • 3 years-Experience in physician inpatient/outpatient billing/coding

Required Certifications/Registrations/Licenses

  • CPC - CERT PROFESSIONAL CODER

In Lieu Of The Minimum Requirements Listed Above

  • If approved, equivalent coding certificationmay substitute for CPC.

Work Shift

Day (United States of America)

Location

Patewood Outpt Ctr/Med Offices

Facility

1046 Patewood Hospital

Department

10457822 Surgery-Vascular-IVH

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.


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