Coding/Revenue Cycle Specialist - OB/GYN Job
HealthPartners - Saint Paul, MN

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Coding/Revenue Cycle Specialist - OB/GYN

Job ID: : 24794
Department: : Specialty Care Coding Services
City: : St. Paul, MN
Location: : HP - St Paul 180 East Fifth
Position Type: : Full-Time
Anticipated Work Schedule: : M-F, 8-5
Hrs/Pay Period: : 80

Job Description: :
The culture at HealthPartners is one of ownership, pride, service, and most importantly, partnership. That spirit of partnership among employees, and with patients and the community is just one of the many reasons we were recently named one of the Twin Cities best places to work by the Minneapolis/St. Paul Business Journal. Join us for a career that offers respect, support and encouragement. You’ll stay for the power of partnership.

Because of our continued growth we are currently seeking a Coding/Revenue Cycle Specialist to join our HealthPartners Specialty Care (OB/GYN) Coding team. This Revenue Cycle Specialist (RCS) will be responsible for partnering with providers and clinic operations staff to support the HealthPartners Revenue Cycle. The RCS is responsible for understanding and optimizing the revenue cycle for their specific department(s) and or clinic location(s). Maintaining a comprehensive understanding of the areas that can hinder optimal revenue capture; an in-depth understanding of coding and compliance rules and regulations; knowledge of Electronic Medical Records (EMR) in the areas of charting tools (i.e. order entry, smart sets etc), charge dropping, charge update, charge review and follow up work-queues. The RCS provides support to providers and clinic staff for CPT, HCPC, and ICD-9-CM coding systems, and acts as a liaison between the delivery sites and compliance operations to support the Provider Monitoring Program and related educational activities around coding, billing and compliance. This person will be coding for various specialties and primary care departments.

SPECIALTY CODING:
This person will be coding for OB/GYN.

ACCOUNTABILITIES:
A.) Revenue Capture

  • Ensures all services provided are accurately captured in the medical record and billed appropriately. This is accomplished using the following methods:
  • One-on-one chart review with each provider
  • In-depth understanding of EMR in the areas of charting tools (i.e. order entry, smart sets etc), charge dropping, and charge update, Charge review work-queues
  • A review of each provider’s individual charting tools and preference lists to ensure accurate CPT, HCPC and ICD-9 coding
  • Investigation into supplies and medications dispensed at each clinic and a review of appropriate billing for them
  • Working all CCI/LMRP edits, claims manager rules and other coding associated charge review WQ rules for each clinic or department supported.
  • The ability to provide feedback to each provider based on identified coding trends.
  • Maintains a current knowledge of regulations and legislation regarding billing compliance issues.
B.) Denial Management

  • Working all coding related denials.
  • Working all coding related patient complaints
  • The ability to provide feedback to each provider based on identified denial trends.
  • Implement changes and provide education & feedback to providers, departments and clinics with regards to denials that impact revenue flow and or capture
C.) Provider Education

  • Provides coding education (HCPC, ICD-9-CM, DSM3-R, & CPT) to providers and clinical staff in accordance to the established corporate compliance plan.
  • Works with the Education & Compliance Specialist to further support and educate providers on their performance in the Provider Monitoring Program.
  • When provider documentation issues are identified, work with clinic management and the Education & Compliance Specialist (ECS) staff to implement corrective action plans.
  • Actively train physicians and other providers on coding and reimbursement issues. Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit.
  • The RCS will be responsible for implementing corrective action plans to improve revenue cycle outcomes. This may include (but not limited to) creating site-specific education, partnering with Revenue Services staff to implement site-specific revenue improvement projects, understanding how to leverage Epic technology to create revenue capture solutions, or suggesting operational changes at each location.
REQUIRED QUALIFICATIONS:
  • Four year college degree or equivalent work experience
  • Three years demonstrated knowledge of coding
  • Certified Professional Coder (AAPC) or Certified Coding Specialist certification (AHIMA)
  • Ability to present information in one-on-one and group settings
  • Ability to communicate information in a professional and confident manner
  • Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice
  • Demonstrated ability in critical thinking, self initiative, and self direction
  • Understanding of physiology, medical terminology, and disease process is required
  • Must understand and be able to apply the following regulations:
  • HCFA’s Evaluation and Management Documentation Guidelines
  • HCFA’s Teaching Physician Guidelines
  • HCFA’s Correct Coding Initiative
  • Third Party Payer Reimbursement Policies and Procedures
PREFFERRED QUALIFICATIONS:
  • Five years working with coding systems.
  • Two years previous experience in medical record chart documentation review.
  • Two years experience in group education with provider audiences.
  • One year working with EpicCare.
  • Two years working in a physician practice setting.
  • Demonstrated PC skills in Word, Excel, and Microsoft Access.
DECISION-MAKING:
  • Works independently to respond to revenue cycle issues.
  • Responsible for completing work assigned by Manager.
  • Responsible for making decisions to coordinate work load and schedule.
  • Responsible for communication with and upholding service standards with clinics, including both providers and administrative staff.
  • Refers critical questions and problems to Manager.
HealthPartners is nationally acclaimed for providing outstanding patient care and we offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.jobs and search for Job ID #24794.

Health is what we do. Partnership is how we do it.

HealthPartners is an Equal Opportunity Employer.

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The largest consumer-governed, nonprofit health care organization in the nation, HealthPartners provides care, coverage, research and...