Position Summary : Responsible for supervising and coordinating the timely and accurate coding and charging of all Trinity Health System provider services (regardless of where provided). Responsible for ensuring procedural compliance with regulatory and professional standards governing coding and billing. Provides coding and billing resources and educational information relevant to professional fee coding. Oversees the review of patient records for professional service charges and other procedures/services rendered to ensure accurate and compliant coding and billing as supported by documentation.
Essential Duties and Responsibilities:
1. Interviews, employs, provides training, establishes work schedules and evaluates performance of all supervised clinic coding and abstracting/billing staff. Maintains working knowledge of job procedures for all clinic services coding and data entry positions.
2. Assists supervised staff with insurance denials, coding questions or problems. Researches insurance denials, processing edits, and direct resubmission of claims for reimbursement with corrections documented.
3. Assist staff in reviewing patient records for appropriate provider charges and other procedures/services rendered to patient to assign correct CPT codes and modifiers to include the necessary information for coding, billing and insurance processing.
4. Assist providers in determining and understanding the Evaluation and Management (E&M) criteria (1995 or 1997) for the levels of care for both new and established patients. Ensure documentation supports selected levels of service.
5. Assist staff and providers in reconciling daily lists of patients seen by Trinity providers to ensure the processing of charge tickets for each provider and for each patient. If charge tickets are missing, identify and follow-up.
6. Assist staff in reviewing and verifying HCPCS, E/M levels, modifiers and post-operative visits and the charges for each of these.
7. Ensures staff communicates with the physician/provider for documentation questions.
8. Is aware of and distributes to staff any coding guidelines, rules and regulations and updates that may affect provider coding or billing. Review third-party information (including CMS) to determine coverage updates and policies affecting coding assignments for each type of provider.
9. Develops and maintains calendar for scheduling of provider visit coding and abstracting/billing staff.
10. Verifies and approves time sheets daily and weekly. Monitors and reviews hours worked, vacation and sick hours for supervised staff, as well as overall attendance patterns to ensure adequate staffing to meet revenue cycle requirements.
11. Prepares performance appraisals for supervised staff. Discusses appraisals with employees at least annually and more often, if required.
12. Assures that supervised staff orientation is provided based on job requirements, initially and ongoing as needed by individuals. Assures that supervised staff has completed annual mandatory education as required.
13. Assures that competency testing for supervised staff is completed on a periodic and timely basis.
14. Resolves conflicts between staff or departments in an effective, responsible and professional manner.
15. Assists in conducting department or section meetings and communicate changes in policies, procedures, and general tasks to supervised staff.
16. Assures employees are familiar with, have access to, and comply with policies and procedures regarding dress code, sick and vacation time and education requirements.
17. Assures employees are familiar with, have access to, and comply with policies and procedures and reference materials which conform to current regulatory requirements. Arrange for staff to attend internal and external education as needed.
18. Performs coding audits on new coder/abstractors as well as periodic audits on existing coder/abstractors. Develops schedule for quality review to be completed in a timely and routine manner, results compiled, and feedback presented to the appropriate personnel.
19. Provides input for preparation and monitoring departmental budget.
20. Establishes and/or updates clinic coding procedures and guidelines. Ensure that all appropriate coding/abstracting staff is trained on new coding procedures.
21. Demonstrates flexibility and willingness to assist with a variety of tasks as needed.
22. Effectively communicates with customers positively, confidentially and professionally.
23. Performs job duties in a timely manner.
24. Maintains high level of confidentiality due to nature of protected health information processed.
25. All other appropriate duties, as assigned.
Minimum Qualifications and Requirements :
1. Licenses and Certifications Required: Certified Professional Coder (CPC). Certified Coding Specialist – Physician (CCS-P) preferred or must obtain within one (1) year of employment.
2. Educational Requirements: Formal Course Work in Medical Terminology, Anatomy and Physiology Courses in addition to appropriate Coding Courses – Outpatient Clinical Coding in the Hospital Clinic Office Setting. Commitment to obtain one of the required credentials within 6 months of employment. HS Diploma or GED required.
3. Experience Requirements:
4. Special Skills or Training Requirements:
- Minimum of five (5) years experience in ICD-9-CM diagnosis coding preferred.
- Minimum of five (5) years experience CPT/HCPCS clinical coding
- Minimum of three (3) years supervisor or management experience.
- Previous experience using computerized systems for abstracting, coding, reports and information storage and retrieval
- Experience with word processing, Excel spreadsheets and Power Point for educational presentations.
5. Physical Requirements / Work Environment:
- Minimum typing skills of 35 characters per minute.
- Medical terminology, anatomy and physiology, pathophysiology and coding knowledge, required.
- Proficient 10 key/calculator skills.
Be available to staff and available to clinical personnel at each of the clinic settings – by physical presence (when necessary) or by phone
i. Sitting : May be up to 7 hours per day
- Individual Physical Abilities:
ii. Standing : Occasional
iii. Walking : Position will require walking throughout the day – staff are located in separate buildings and areas within buildings
iv. Lifting : Occasional – up to 20 pounds with good body mechanics
v. Twisting : Infrequent
vi. Bending : Infrequent
vii. Squatting/Kneeling : Infrequent
viii. Reaching : Infrequent
ix. Pushing/Pulling : Occasional - up to 25 pounds with good body mechanics
x. Carrying : Occasional – up to 20 pounds with good body mechanics
xi. Wrist Position : Full range of motion for computer utilization daily
xii. Manual Dexterity : Fine motor skills required for computer work
xiii. Vision : Require accurate vision for computer and data integrity work
xiv. Hearing : Required for communication with staff, providers and customers
xv. Verbal Communication : Required for communication with staff, providers and customers
i. Noise : Normal office environment sounds
ii. Working with others : Significant association with staff, providers, and customers
iii. Pace of Work : High level of performance, multiple tasks, priority setting and timelines
iv. Irregular/Extended Hours : Moderate and occasional
v. Driving : Required between physical healthcare sites where HIM staff are located