Provider Coding Specialist II

Job Description

Description

PeaceHealth is seeking a Provider Coding Specialist II for a Full Time, 1.00 FTE, Day position.  Hourly compensation starts at $28.34, more depending on experience.

Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.

JOB SUMMARY

This position is responsible for ensuring accurate and consistent procedural/diagnostic coding and documentation, providing specialty procedural review/auditing services, and proactively coding regulatory information and education.

ESSENTIAL FUNCTIONS

1. Researches and provides education to providers, clinic management and staff regarding specialty procedural coding and coding and compliance issues utilizing regulatory and medical informational resources.
2. Collaborates with other coding staff to identify trends and issues with provider coding practices and edits, reviews monthly edit and denial reports to make recommendations for provider and staff education.
3. Ensure that all services and charges have been accurately submitted for assigned providers/department. Understand process for processing charges for PBE, Method 2, or standard charge processing. Code all services timely and appropriately. Process all work in work files, issue trackers, and fee tickets according to departmental guidelines and targets.
4. Maintain a weekly presence within clinical areas assigned to. Responsible to work with clinical managers and staff to create and maintain appropriate charge capture and coding workflows. Meet with provider staff regularly to discuss any issues related to charge capture and coding process. To include filling out of forms, accurate and timely documentation, changes in coding or payer guidelines that impact coding and/or payment.
5. Provide quarterly physician documentation education to assigned providers. Develop presentation to include coding statistics, review of at least 10 services, and discussion of any areas that need changes in either coding or documentation. Assist providers with understanding coding and documentation requirements, providing any and all tools to assist with accurate documentation. Determine any follow up actions from the quarterly meeting. Appropriate follow up consists of, but is not limited to, shadowing in all clinical environments, review of services on a weekly basis, 100% review of specific procedures, and meetings with all providers to discuss coding rules.
6. Conduct reviews of provider documentation and peer coding accuracy reviews. Provider reviews will be documented within MD Audit. One of the quarterly reviews each year will be a scored review housed within MD Audit that will satisfy our internal quality control. Conduct and document peer-coder reviewers on a semi-annual basis. Re-reviews of coders and providers will be consistent with PeaceHealth policy
7. Collaborates with Provider Review/Education Specialists in development and presentation of provider education materials in individual and group settings.
8. May process billing system claim edits during periods of large workflow volumes.
9. Participates in departmental and cross regional meetings and projects involving coding/billing and helps develop forms/process for use in clinics.
10. Maintains communication and relationships with PFS billing and reimbursement management and staff regarding issues affecting coding and charge capture. Instructs coding staff as to completion of updates.
11. Meets with lead providers/clinical administration to facilitate annual revisions of encounter forms and to distribute code update information.
12. Review provider coding practices and provide recommendations and feedback.
13. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

• High school diploma or equivalent preferred. Knowledge of anatomy, physiology, medical terminology, diseases, procedures and therapies.

EXPERIENCE/TRAINING:

• Minimum of three years’ experience in physician professional services coding in a medical care facility, billing office or medical records department.

LICENSE/CERTIFICATION:

• CPC (Certified Professional Coder); Certified Outpatient Coder (COC) or CCS-P (Certified Coding Specialist – Physician Based) required.
• RHIT or RHIA preferred.

OTHER SKILLS:

• Proficiency in coding Professional Inpatient and/or Ambulatory Care, Emergency Department and Outpatient medical records with ICD-10 CM and CPT4 classification systems with expertise in one or more specialty area.
• Proficient in the use of MS Office applications including Excel and Word.
• Adept and proficient in windows based computer environment with respect to coding software systems.
• Good verbal and written communication skills
• Critical thinking and problem solving skills required.
• Public speaking/presentation skills
• Familiarity with medical billing software and electronic medical record preferred.

PHYSICAL/COGNITIVE REQUIREMENTS:

• Work requires normal amounts of physical effort from 34 to 65% of the time.
• Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.
• Extended periods of sitting while reviewing records and entering clinical data into a computer monitor where noise level is moderate.
• Duties require the ability to concentrate or pay close attention to detail (more than 65% of work time).

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For full consideration of your skills and abilities, please attach a current resume with your application.  EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.