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Certified Professional Coding & Billing Specialist

Company: Cambridge Health Alliance
Location: Malden
Posted on: May 28, 2023

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


The department provides critical oversight of the revenue cycle for Cambridge Health Alliance including actively participating in front end and back end processes.

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.

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.


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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