Frederick Health
Location
Frederick County, Maryland
Salary
$26 - $38 / HOUR
The specialist independently reviews clinical documentation and diagnostic results to ensure accurate procedural and diagnostic coding for professional services rendered, validating that coded services are supported by appropriate documentation and medical necessity. Responsibilities also involve charge capture aspects, ensuring charges are entered correctly into the billing system based on payor contracts, billing rules, and other requirements for various service types.
A High School Diploma or GED is required, though post-secondary education in Medical Coding or an Associate’s Degree is preferred, along with 3-5 years of required experience, including surgical coding experience. Candidates must be certified through AAPC as a Certified Professional Coder (CPC) and must adhere to a 95% quality accuracy standard.
Under minimal direction, the Charge Capture Coding Specialist is responsible to independently, accurately, and timely reviews clinical documentation and diagnostic results as appropriate to validate and ensure correct procedural and diagnostic coding of professional service rendered for the Frederick Health Medical Group providers.
Coders are responsible for the validation of provider, supplies, and/or diagnostic services rendered to patients documented in the medical record are “coded” correctly as well as assuring coded services are supported by appropriate documentation including medical necessity. Coders are objective to the service provided regardless of physician or patient. Charge specialists are involved in charge capture aspects to ensure that “charges” are entered into the billing system based an assortment of requirements; payor contracts, billing rules (bundling and unbundling of services), place of service, claim sequencing, diagnosis pointing for medical necessity, patient/demographic information, eligibility, etc.
The Charge Capture Coding Specialist is responsible for assigned work queue’s for physician services via medical records (encounter) for office visits, outpatient surgery, office procedures, ASC procedures and hospital visits utilizing ICD-10-CM and CPT-4 codes. This requires thorough review of the medical record to validate assigned codes for optimal reimbursement. The Coder is responsible to research coding and regulatory guidelines that impact coding and billing for services to obtain relevant and timely information for internal utilization utilizing ICD-10-CM and HCPCS/CPT-4 codes. Ensures appropriate charge capture.
This position supports the Frederick Health mission, vision, core values and customer service philosophy and adheres to the Frederick Health Compliance Program, including following all regulatory requirements and the Frederick Health Standards of Behavior.
· Reviews available electronic and other appropriate documentation within the Expanse Meditech System to identify all billable ambulatory procedures and services for the assigned specialty/provider ensuring all appropriate ICD-10, CPT and/orHCPCS code(s) and quantities are charged.
· Consults with physicians, through 3M360 and/or clinical department representatives, as appropriate, to verify services were rendered, documented and meets the requirements for coding as an ambulatory procedure.
· Employees must perform all duties and responsibilities in accordance with the AAPC/AHIMA Standards of Ethical Coding and Company’s code of Ethics and Business Conduct.
· Collects and analyzes outpatient clinical information to accurately report codes and abstract relevant information used for reimbursement.
· Demonstrates a high degree of independence in performance of responsibilities, working effectively with the department team members and management.
· Exhibits strong time management, problem solving and communication skills.
· Is able to effectively utilize various computer systems in performance of job functions.
· Demonstrates an understanding of the billing cycle. Prioritizes data in accordance with established guidelines of all governmental regulatory agencies and third-party payers.
· Demonstrates competency in coding and abstracting outpatient records in accordance with ICD-10-CM/PCS and CPT-4 coding conventions and national coding guidelines.
· Participates in continuing education opportunities and shows initiative in researching difficult or interesting subjects. Shares the information with the rest of the team.
· Understands coding conventions/rules as published in the AMA CPT Professional Coding, Online Encoder Pro etc…. as well as changes in medical terminology and advances in medical and surgical procedures.
· Responsible to review annually all coding changes to ensure knowledge of all new, changed or deleted codes
· Actively participates in new provider on boarding.
· Meets with providers to go over documentation deficiencies as needed or monthly. (as determined by department leadership)
· Other Duties as assigned
Pay is based on experience, skills and education. If position is part-time, salary will be pro-rated based on scheduled hours. The pay range may also vary within the stated range based on specialty if applicable. Non-Exempt positions may have shift differential and/or Overtime paid, if applicable.
$26.46 - $37.80
Monday-Friday, 8:00am-4:30pm.
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