The Professional Fee Coder I is responsible for coordinating accurate and timely submission of professional fees. S/he ensures the medical record reflects adequate attending physician documentation per practice plan and CMS/HCFA guidelines. Close collaboration with clinical departments and physicians is required.
The Professional Fee Coder I is an entry and intermediate level position responsible for performing primarily E&M; as greater than 50% of their work with some procedures initially and could develop to coding more procedures depending on assigned specialty. This position has a minimal to moderate degree of complexity. The Coder I will work under direct supervision.
- High School Diploma or equivalency.
- Graduation from an accredited HIM program preferred.
- ICD-10 coding courses preferred
- 1 year experience in a healthcare environment required
- 1 year coding experience preferred.
For experienced coders, this position has the potential to be a Professional Fee Coder II. The requirements are:
- 3 years professional fee coding experience with at least 2 years abstract Procedural/Surgical Coding experience as greater than 50% of work or 6 years professional fee coding experience with greater than 50% of work E&M; coding.
- Experience coding in a Teaching Physician environment preferred.
- 2 years coding or related medical field, CPT, and ICD-9/10 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.
- Experience in an academic healthcare environment preferred.
- Certification as CPC-A, CPC, RHIT, RHIA, CCA, CCS-P or specialty AAPC coding certification required. Other certifications subject to review.
- ICD-10 Proficiency passed or possesses an ICD-10 Trainer certificate.
Knowledge, Skills & Abilities:
- Knowledge of Anatomy and Physiology
- Knowledge of ICD-10 coding guidelines.
- Ability to accurately complete detail-oriented work in a timely manner.
- Ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.
- Ability to prioritize workload and meet quality and production standards.
- Ability to read and understand written sentences and paragraphs in work related documents.
- Ability to work well with a variety of people and be a team player.
- Excellent oral and written communication skills, with the ability to convey a positive and professional image, and to interact effectively with diverse personalities and backgrounds.
- Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Strong customer service and relationship management skills.
- Proficiency with Windows based software and Microsoft Office Suite products in a network environment.
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 all applicable data sources (EPIC, ORCA, Mindscape,) 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-10 codes. Ensures coded services, provider charges and medical record documentation meet appropriate guidelines or standards.
- Reviews and resolves coding denials and coding claim edits in Epic daily as part of routine operations.
- Consult with physicians, as appropriate, to verify services rendered and documented. Provide feedback to assist in provider understanding of coding and documentation issues and opportunities.
- Assist physicians and/or their representatives with questions pertaining to professional fees.
- Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. May participate in “huddles,” Grand Rounds, or department specific sessions to facilitate timely and relevant feedback.
- For services coded, enter charges and comments in Epic.
- Utilize appropriate methods to ensure all documented professional services are submitted in a timely manner.
- Resolve any (outpatient and inpatient) coding edits in the Epic charge review 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.
- Perform other duties, as assigned.
Production & Quality Standards
- Maintain established monthly production standards relating to charge review, charge entry, claim edits, and denials.
- Provides consistent and timely feedback to physicians.
- Greater than 50% of workflow is E&M; coding only
- Maintain established Quality Assurance standard during scheduled coding audits.
ACCOUNTABILITY: Employee can be relied upon to consistently deliver on commitments and promises. Demonstrates a willingness to take responsibility for self and own work. Accepts responsibility for positive and negative outcomes of judgments and refocuses efforts when appropriate.
COMMITMENT AND TEAMWORK: Employee develops and promotes positive working relationships with peers, management and other departments within UW Medicine. Supports team by listening attentively and expresses ideas clearly and concisely. Demonstrates a positive attitude, shares information and knowledge and promotes the mission, vision and values of UWP and the UW Medicine Health System. Provides honest and constructive feedback to others and respects differing values, opinions and viewpoints.
PROFESSIONALISM: Employee demonstrates an attitude, demeanor, commitment, and appearance that reflects Service Culture Guidelines. Committed to personal excellence and ongoing professional development. Ability to deal with stressful situations and expresses opinions and points of view in a way that promotes positive exchange. Able to speak and write in a variety of settings and styles and convey messages that result in the desired effect.
ADAPTABILITY AND TIMELINESS: Employee is willing to contribute to and carry out new ideas or methods to improve efficiency and is willing to adapt to change. Uses time effectively and efficiently. Concentrates efforts on the most important priorities first.
CUSTOMER/PATIENT FOCUS: Employee is dedicated to meeting the expectations and requirements of all internal and external customers. Achieves service excellence by adding value to the customer request. Views situations from the customer’s point of view and keeps the customer’s needs in mind at all times.
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. This job description may be updated from time to time when duties and responsibilities change as business necessitates.
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. Must be able to meet all productivity and quality standards required for the position with or without accommodation.
UW Physicians is an Affirmative Action and Equal Opportunity Employer for Minorities, Females, Protected Veterans and Persons with a Disability.
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