Coder - Certified

Reports to the Manager of Professional Coding. Under general supervision and in accordance with the policies and procedures established by BMG Professional Coding, reviews and accurately codes office and hospital procedures for reimbursement requiring exercise of initiative and judgement.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Performs routine and non-routine revenue cycle, billing, coding and insurance functions by:

• Extracting relevant information from patient records, examining documents for missing information.
• Liaison with physicians and other parties to clarify information.
• Analyzing documentation and accurately applies CPT, ICD, and HCPCS codes to support compliant coding.
• Working rejected and denied claims based on assigned reports, and assists in complex denial resolution.
• Communicating updates on coding related changes and billing opportunities and guidelines to supervisor and/or providers.
• Assisting providers with required documentation, compliant coding and reimbursement.
• Monitoring provider documentation for trends and adherence to documentation standards and regulatory requirements through report and billing analysis. Communicates results to providers and management as needed.
• Participating in timely review of provider documentation and communication of results to supervisor.
• Auditing reports as necessary to identify and correct coding related errors.
• Achieving BMG's coding productivity and accuracy rates within 6 months of hire; maintains rates as evaluated by internal or external review.

Performs other functions to maintain personal competence and contributes to the overall effectiveness and efficiency of the department by:

• Working closely with other BMG Central Business Office associates.
• Presenting coding and compliance related topics to team members.
• Completing other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

 

Education and Experience

• The knowledge, skills, and abilities are normally acquired through a High School diploma, GED or suitable equivalent. Graduate of an accredited medical coding program preferred. Two years physician coding experience in an applicable specialty preferred. Designation as a Certified Coding Specialist-Physician Based, Certified Professional Coder, Certified Medical Coder, or Certified Coding Associated required. Must complete a minimum of 12 hours of coding related education per year to field of concentration.

Knowledge & Skills

• Requires accuracy and proficiency with CPT, ICD and HCPCS code assignment.
• Demonstrates knowledge of regulatory and payer specific coding guidelines.
• Demonstrates proficiency in knowledge of anatomy, physiology and medical terminology.
• Demonstrates exceptional organizational skills and attention to detail.
• Proficient computer skills in data entry, coding, and knowledge of Electronic Medical Record software; Microsoft Office Suite.
• Ability to work independently and as a member of a team.
• Requires excellent communication skills, both oral and written, necessary to effectively speak to a diverse audience.
• Demonstrates working knowledge of HIPAA and ability to maintain confidentiality of all data.

Working Conditions

• Works in an office environment.
• May experience some mental/visual fatigue from careful and constant review of records, code books, and continued use of computer equipment.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.