Professional Fee Coder
Department:  Coding & Charge Capture
Reports to:  Manager, Coding & Charge Capture
FLSA Status:  Non-exempt
Bargaining Unit:  Yes
Salary Level:  21

Position Summary

Coordinate accurate and timely submission of professional fees. Ensure the medical record reflects adequate attending physician documentation per practice plan and CMS/HCFA guidelines.

Qualifications

Education:
  • High School diploma or equivalency.
Experience:
  • Two years experience in coding or related medical field, CPT and ICD9 coding experience, and on-line data entry with ability to interpret physicians’ documentation and identify/extract billable services from medical records.
  • Experience interacting with physicians regarding coding requirements.
Certifications/Licensure Requirements:
  •  Certification as CPC, RHIT, RHIA or CCS-P
Knowledge, Skills & Abilities:
  • Effective communication skills, both written and verbal.
  • Knowledge of anatomy and physiology.

Essential Duties and Responsibilities

  • Identify all billable services (regardless of location rendered) requiring professional fee billing, as determined jointly by UWP and the Clinical Department:
    • Review status of admitted and discharged patients.
    • 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.
    • 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 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 and targeted training to physicians and other providers regarding coding guidelines and requirements. Participate in “huddles” to facilitate timely and relevant feedback.
  • In conjunction with Compliance Trainer and Physician Champion, 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 system and repetitive 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, physician champions, 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.
  • Perform other duties, as assigned.

Production standards

  • Maintain established monthly production standards relating to number of services coded, charge review edits worked, and coding denials addressed.
  • Provide consistent and timely feedback to physicians.

Quality Assurance

  • Maintain satisfactory Quality Assurance review scores.

Standard Job Responsibilities

  • Conduct business with employees, patients, the School of Medicine, physicians and outside parties in a professional appropriate manner conducive to maintaining good working relations.
  • Follow all UWP policies.
  • Conduct all activities with safety in mind.
  • Meet attendance expectations.
  • Adhere to all company policies and procedures.
  • Represent UWP confidentially and professionally at all times.
  • Act in support of UWP’s Mission, Vision, and Values.

The duties and responsibilities listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.

Compliance Requirements

All non-management positions require adherence to the UWP Code of Conduct and UWP Billing Compliance Policies and related training requirements. Incumbents must demonstrate knowledge and understanding of the confidentiality of employee information, UWP plans, initiatives, and financial information, and patient privacy rights. Job duties must be performed with minimum access to and use of UWP, employee, and/or patient information. Incumbents are required to promptly report all compliance concerns.

Physical Demands/Working Conditions

Must be able to perform work, with or without accommodation, within a normal office environment involving sitting, standing, keyboarding, and occasional reaching, stretching, bending, moving about, and lifting up to 10 pounds.

Selection: Selection is based on the candidate meeting the required qualifications, demonstration of related experience and/or education, favorable attainment of references, and the candidate's ability to fulfill the described job responsibilities.

Application: To apply for this position, please complete this Equal Employment Opportunity Affirmative Action Form. After completing the form you will be provided with further instructions for submitting your cover letter and resume to complete the application process. If you are applying for more than one position, please complete this process for each position.

 

EQUAL OPPORTUNITY EMPLOYER