Certified Professional Coding & Billing Specialist
Company: Cambridge Health Alliance
Location: Malden
Posted on: May 28, 2023
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Job Description:
Location: Commerce Place
Work Days: Monday - Friday, 8am - 4:30pm
Category: Professional and Management
Department: Revenue Integrity
Job Type: Full time
Work Shift: Day
Hours/Week: 40 hours per week
Union: No
Union Name: Non Union
DEPARTMENT DESCRIPTION:
The department provides critical oversight of the revenue cycle for
Cambridge Health Alliance including actively participating in front
end and back end processes.
Summary:
Working under the direction of the Coding Services Manager and
exercising independent judgment within the scope of their
professional practice, the Certified Professional Coding & Billing
Specialist performs a variety of tasks associated with coding
physician and other provider charges, and providing coding
education to providers in that area. Duties include hands-on
coding, documentation review, coding dictionary updates, resolving
rejections and denials via appeal and/or adjustment, surgical
coding, physician or other care provider education, and other
coding needs for ICD-9, ICD-10 and CPT coding of inpatient and
outpatient professional charges.
Responsibilities:
Coding Responsibilities:
--- Provides review and/or coding of any professional services
including but not limited to surgeries, encounters, and diagnostic
services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, and
Modifier usage/linkage as well as provide ICD-9 and/or ICD-10
coding where needed for handwritten/missing diagnoses. Provides
same for areas where work files are used. In areas where paper is
used, reconcile daily charges against log (if available/applicable)
to ensure daily capture of coding charges expected. Productivity
and accuracy for work file and non-work file standards must be met
according to guidelines set by manager.
--- Review and assist in updates of coding dictionaries/encounter
forms/charge slips as needed for accuracy of CPT, HCPCS and ICD-9 &
ICD-10 Coding.
--- Periodic review of codes, at least annually or as introduced or
require for new, revised, or deleted code updates.
--- Answers and responds accurately and timely to questions on the
telephone, voice mail, e-mail, Coding Hotline and/or Coding Website
as appropriate.
--- Reviews and analyzes rejected claims and patient inquiries of
professional services, and recommends appropriate coding
corrections to appropriate parties. Resolves claims by processing
necessary appeals accordingly.
--- Reports regularly on daily activity, productivity, and findings
of reviews/rejections/education via electronic file or database,
e-mail, paper, or other means as required by manager.
Physician/Provider Education:
--- Confers regularly with physicians/care providers, clinical or
ancillary managers, coders, or other staff through departmental
staff meetings, one-on-one meetings, and/or daily interactive
communication to respond to and educate providers on specific
departmental and clinic wide coding issues and updates including
but not limited to the coding hotline and/or the coding
website.
--- Participates in new physician/care provider orientation as well
as provide follow-up reviews and education for the new
physician/care provider if applicable for the area of
responsibility.
--- Provides feedback, recommendations, and participates as the
coding representative for the Professional Coding Department on the
Revenue Cycle Teams as requested by manager.
--- Develops and conducts a schedule of physician/care provider
documentation reviews in areas where applicable and/or as defined
by manager.
--- Provides feedback to the physician/care provider, Department
Chair, and/or Administration as required.
--- Documentation review is ongoing and feedback will be provided
to the physician/care provider, Department Chair, and/or
Administration as required.
--- Education & Professional Development:
--- Researches and stays updated and current on CMS (HCFA), AMA and
Local Coverage Determinations (LCD's), or Local Medical Review
Policies (LMRP's) to ensure compliance with coding guidelines.
--- Communicates new guidelines to providers through physician/care
provider and/or departmental meetings.
--- Stays current on quarterly CCI Edits, bi-monthly Medicare
Bulletins, Medicare's yearly fee schedule, Medicare Website, and
specialty newsletters.
--- Recommends updates/additions/deletions to the Coding Library as
changes / regulations require.
--- Organizational Requirements:
--- Maintains strict compliance with CHA and CHAPO Policies and
Procedures. Incorporates CHA and CHAPO Guiding Principles, Mission
Statement and Goals into daily activities.
--- Complies with behavioral expectations of the department and
CHA/CHAPO.
--- Maintains courteous and effective interactions with colleagues,
providers and patients.
--- Demonstrates an understanding of the job description,
performance expectations, and competency assessment.
--- Demonstrates a commitment toward meeting and exceeding the
needs of our customers and consistently adheres to Customer Service
standards.
--- Participates in departmental and/or interdepartmental quality
improvement activities.
--- Participates in and successfully completes Mandatory
Education.
--- Maintains minimum certification requirements for coding.
--- Performs all other duties as needed or directed to meet the
needs of the department.
MINIMUM QUALIFICATIONS:
Education: High School Diploma or equivalent, plus additional
specialized training associated with attainment of a recognized
Coding Certificate.
CPC (Certified Professional Coder through American Academy of
Professional Coders) or CCS-P (Certified Coding Specialist
Physician based through American Health Information Management
Association) is required.
Computer skills: Proficient in Microsoft Office (Word, Outlook,
Access, and Excel). AthenaNet, Meditech and/or Epic systems
experience preferred.
Work experience:
Minimum 2 years Professional Coding experience in conjunction with
requirements indicated above; or 4+ years coding or related
experience in a private practice.
Ideal candidates should have experience in professional coding,
claims management, denials, and appeal processes. Those considered
for this position should be highly organized, self-motivated and
have demonstrated critical thinking skills. The ability to
communicate effectively and to portray a professional image is
essential.
Candidates must be able to read and interpret an EOB (Explanation
of Benefits), Remittance Advice and CMS 1500 data elements. They
must have working knowledge of the CPT and ICD-9/ICD-10 guidelines.
Also required to identify managed care denials and understand
contract reimbursement.
Demonstrates a thorough understanding of the body of knowledge
required for attainment of a college-level coding certificate as
indicated above.
Knowledge of research techniques to collect, analyze and interpret
data and make recommendations.
Knowledge of legal and fiscal requirements and regulations.
Strong knowledge of finance and accounting computer systems,
spreadsheets (Excel), databases (Access) and other
applications.
Knowledge of claims management, denials and appeal processing.
Knowledge of medical terminology and professional coding
methodologies to include DRG, RBRVS, CPT, HCPC and ICD coding
principles and code-sets.
Skill in problem recognition, escalation and resolution.
Skill in interpreting and analyzing financial data and reports.
Skill in examining documents and interpreting their accuracy.
Skill in both verbal and written communication.
Skill in effectively communicating with all levels of management
and physicians.
Skill in establishing and maintaining effective working
relationships.
Skill in preparing and effectively presenting financial
information.
Ability to exhibit a high degree of individual initiative,
independent judgment and effectively articulate thoughts and
conclusions.
Ability to prepare and analyze claims detail to identify trends
and/or root cause.
Ability to develop coherent presentations of results
Ability to perform mathematical and statistical computations
quickly and accurately.
Ability to work with business computer applications, spreadsheets
and databases.
Ability to effectively communicate and educate others in sharing
knowledge and providing direction within the scope of the job.
In keeping with federal, state and local laws, Cambridge Health
Alliance (CHA) policy forbids employees and associates to
discriminate against anyone based on race, religion, color, gender,
age, marital status, national origin, sexual orientation, gender
identity, veteran status, disability or any other characteristic
protected by law. We are committed to establishing and maintaining
a workplace free of discrimination. We are fully committed to equal
employment opportunity. We will not tolerate unlawful
discrimination in the recruitment, hiring, termination, promotion,
salary treatment or any other condition of employment or career
development. Furthermore, we will not tolerate the use of
discriminatory slurs, or other remarks, jokes or conduct, that in
the judgment of CHA, encourage or permit an offensive or hostile
work environment.
Cambridge Health Alliance brings Care to the People - including
your neighbors, friends and family. Our local hospitals and care
centers serve our vibrant, diverse communities, and play an
integral role in improving health. As passionate advocates for the
underserved, we actively partner with our communities to take on
challenging public health issues, and conduct important research to
help reduce barriers to care . click apply for full job details
Keywords: Cambridge Health Alliance, Malden , Certified Professional Coding & Billing Specialist, Accounting, Auditing , Malden, Massachusetts
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