Coder II - Professional Services Billing

FLSA Status

Job Role Summary

The Professional Coder provides timely and accurate clinical coding and abstraction of inpatient and outpatient services as appropriate to facilitate compliant and optimized reimbursement, research, and PI initiatives. The Professional Coder is responsible for the coding, abstraction, and charge entry (as applicable) of one or more of the following: professional and facility services which may include evaluation and management services, ancillary/diagnostic services, and behavioral health services.

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health’s values
• Coding and Abstracting:  Identifies and assigns the appropriate diagnosis, procedure, and evaluation and management (E&M) codes in accordance with coding guidelines and departmental standards; audits notes from providers to ensure the provider is coding in a compliant manner according to governmental rules and regulations; provides feedback to the provider if there are any questions or concerns; meets with providers face-to-face to review documentation and coding guidelines as necessary; maintains acceptable levels of performance related to productivity and quality standards
• Charge Entry:  Captures charges accurately based on documentation, and integrates charges and codes appropriately; makes suggestions for additions to the fee schedules based upon recognition of new procedures and/or supplies
• Problem Solving:  Utilizes available resources appropriately to maintain quality and consistency in coding, abstraction, and charge entry processes; follows a defined process to query the medical staff for completion and/or clarification of documentation necessary to ensure coding compliance and accuracy; brings any concerns/issues to management’s attention with examples within the same date of discovery. 
• Medical Necessity:  Recognizes cases that require specific medical necessity coverage diagnoses, and applies Local Coverage Determination (LCD) policies as necessary
• Helps Accounts Receivable Specialists with questions and concerns to ensure claims are compliant and accurate for submission and payment
• Assists with training of new team members
• Software Applications:  Utilizes applicable software to retrieve documentation, abstract data/codes, and retrieve work lists
• Stays updated on program specific changes where applicable.

Job Requirements

• Requires a minimum of High School diploma and coding credential from AHIMA or AAPC
• Requires a minimum of 3 years of coding experience in ICD-10, CM, CPT-4, and HCPCS coding classification systems, preferably in a physician and/or mental health physician office//hospital setting.
• Epic experience a plus
• Dental, vision, and/or DME coding a plus

Knowledge, Skills & Abilities

• Local Coverage Determinations (LCDs), Correct Coding Initiative (CCI) edits, and the healthcare billing process
• Diagnostic and therapeutic tests, surgical procedures, and medical record documentation standards and retrieval
• E&M guidelines, documentation requirements, and assignment for hospital inpatient and outpatient professional services
• Apply medical necessity coverage determinations as applicable, and seek coverage in the medical record documentation
• General computer skills, and ability to learn new skills quickly
• Computerized abstracting systems
• Revenue cycle process
• Experience with clinical documentation improvement programs
• Experience in concurrent coding environment
• Excellent and professional oral and written communication skills
• Excellent and professional customer service and organizational skills
• Ability to work as an effective team member
• Recognizes opportunities for improvement and brings them to management’s attention with suggestions
• Sets and adjusts priorities to meet departmental goals
• Works independently and exercises professional judgment to meet daily operational demands
• Demonstrates team oriented, professional conduct when resolving operational issues which cross operational units within Eskenazi Health