The Lead Professional Fee Coder is responsible for assuming a leadership role with the Coding & Charge Capture Department, guiding daily production and workflow of coders when the supervisor is unavailable. S/he will possess a thorough knowledge of coding guidelines and will demonstrate effective problem-solving skills and work with more complex and/or specialized accounts/projects.
- High School Diploma or equivalency.
- 3 years in medical billing or related medical field, CPT and ICD9/10 coding experience, and on-line data entry with ability to interpret physicians’ documentation and identify/extract billable services from medical records.
- Experience in an academic healthcare environment preferred.
- Certification as CPC, RHIT, RHIA, or CCS-P required.
Knowledge, Skills & Abilities:
- Knowledge of Anatomy and Physiology.
- Experience interacting with physicians regarding coding requirements.
- Knowledge of ICD-10 coding guidelines with ability to successfully complete ICD-10 training and certification by October 2014.
- Ability to complete detail-oriented work in a timely manner.
- Ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.
- Ability to prioritize workload and meet quality and production standards.
- Ability to read and understand written sentences and paragraphs in work related documents.
- Ability to work well with a variety of people and be a team player.
- Excellent oral and written communication skills, with the ability to convey a positive and professional image, and to interact effectively with diverse personalities and backgrounds.
- Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Strong customer service and relationship management skills.
Proficiency with Windows based software and Microsoft Office Suite products in a network environment.
Identify all billable services (regardless of location rendered) requiring professional fee billing, as determined jointly by UWP and the Clinical Department:
o Review status of admitted and discharged patients.
o Review all applicable data sources (EPIC, ORCA, Mindscape, CRDB) or other, as applicable, for new admissions,
transfers, discharges, expirations, ambulatory procedures, ambulatory visits or other possible sources of billable services.
o Access and review all available electronic or other appropriate information to identify billable services
requiring professional fee billing.
- As necessary, request patient medical charts (for non-electronic providers).
- Code all documented required professional services, ensuring all are coded using the appropriate CPT & ICD-9/10 codes. Ensure coded services, provider charges and medical record documentation meet appropriate guidelines or standards.
- Consult with physicians, as appropriate, to verify services rendered and documented.
- Assist physicians and/or their representatives with questions pertaining to professional fees. Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. Participate in “huddles” to facilitate timely and relevant feedback.
- In conjunction with compliance educators, assist with educational in-services for physicians, other providers and clinical staff relating to documentation compliance as well as new policies and procedures related to billing, as requested.
- Complete Charge Reconciliation Log / Charge Entry Sheets with the pertinent billing information for data/charge entry.
- For services coded, enter charges and comments on the on-line charge entry system.
- Review charges to ensure they are consistent with NCCI and MPFSB standards.
- Utilize appropriate methods to ensure all documented professional services are submitted in a timely manner.
- Maintain Charge Reconciliation Database (CRDB) tracking log to ensure all appropriately documented procedures are billed in a timely manner.
- Resolve coding issues in the Epic charge edit work queues. Bring common issues to attention of supervisor and physician champions to provide timely feedback loop designed to address root cause and prevent ongoing errors.
- As necessary and appropriate, work with claims specialists, practice advisors, applications management, EPIC and other Supervisory or Managerial staff to resolve any billing issues.
- Conduct progress billing for long-term patient accounts. Ensure progress billing occurs according to agreed upon standards set jointly by UWP and the Clinical Department, utilizing any available tools such as Hospital Professional Fee work queues sorted by admit date and/or Charge Reconciliation Database date sort.
- Assist charge capture staff with questions, identify training areas, and properly code complex or difficult accounts.
- Assist in unit quality monitoring, projects, trend analysis, and reports, as directed by supervisors, Managers, and/or directors.
- Organize, update, and make readily accessible, all references, documents, policies and procedures.
- Contribute to and support the corporate quality and production initiatives, by encouraging team and individual contributions to ensure our improvement efforts.
- Perform other duties, as assigned.