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Description
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.
PRIMARY PURPOSE
Responsible for coding, validating, and entering departmental charges daily. Responsible for researching departmental charge discrepancies and working with other departments/organizations to make necessary corrections and coding changes to charges. Responsible for quality review audits.
MINIMUM SPECIFICATIONS
Education
- Must have a High School diploma or GED.
- Must successfully completed an approved coding program OR must be a graduate of a Health Information Management program.
Experience
- Three (3) years of related experience in a acute care setting or diverse clinical specialties required.
- Physician or facility coding, billing, or charge entry experience preferred.
Equivalent Education and/or Experience
- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.
Certification/Registration/Licensure
- Preferred Certification through the American Health Information Management Association as one of the following:
- Registered Health Information Management Technician (RHIT)
- Registered Health Information Management Administrator (RHIA)
- Certified Coding Specialist (CCS) - Certified Coding Specialist
- Physician Based (CCS-P)
- OR -
- Preferred Certification through the American Association of Procedural Coders (AAPC) as one of the following:
- Certified Professional Coder (CPC)
- Certified Outpatient Coder (COC)
- Certified Professional Coder Apprentice (CPC-A)*
- Certified Professional Coder-Hospital (CPC-H)
- Certified Professional Coder-Hospital Apprentice (CPC-H-A)* *If hired with CPC-A or CPC-H-A certification, employee must have apprentice designation removed from their certification within two years to continue in Coder I classification.
Skills or Special Abilities
- Strong coding and charge review skills understanding the utilization of modifiers and other coding, charging and billing rules to include AMA and other state and federal organizations.
- Strong knowledge of, CPT-4/HCPCS, HCC and HEDIS CAT II coding and abstracting, applicable coding edits and general knowledge of Local Coverage for professional billing.
- Strong working knowledge of medical terminology, the human disease process, anatomy and physiology.
- Moderate MS Office suite skills and working knowledge of electronic health records, Computer Assisted Coder (CAC) and encoder software Must have knowledge of third-party payors and understand managed care and insurance coverage, eligibility, explanation of benefits, and the billing process.
- Must be detail oriented, possess basic mathematical skills, and have sharp analytical skills to resolve complex financial issues.
- Must demonstrate a positive demeanor, professional skills/approach, good verbal and written communication skills.
- Must demonstrate teamwork and interpersonal skills. - Epic experience, preferred.
Responsibilities
1. Provides daily review of services provided. Verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.
2. Assigns appropriate evaluation and management (E/M) level, CPT/HCPCS-codes according to the Centers of Medicare & Medicaid Services (CMS), AHA, AMA and other state and federal requirements.
3. Research and monitors areas of compliance, workflow, business processes and recommends policies, procedures and/or other changes to improve charging consistency and charging effectiveness.
4. Assists in management/reconciliation of patient accounts with charge discrepancies by researching issues and working with Patient Financial Services (PFS), Health Information Management (HIM) and revenue generating department(s) to ensure account adjustments are made in a timely manner.
5. Ensures complete and accurate information is provided for coding and billing to ensure revenue is applied appropriately.
6. Monitors and tracks quality and productivity by auditing accounts to ensure adherence to charging policies and procedures. Participates in ongoing quality monitoring and training, policy review and process improvement activities.
7. Works with Charge Capture Coordinator and/or management to coordinate workflow activities.
8. Identifies ways to improve workflow and customer satisfaction and make recommendations to Charge Capture Coordinator and/or management to improve upon these areas.
9. Supports and provides expertise in the charge generation process for the revenue generating department(s) to achieve accurate charging practices and/or improvement in charge generation.
10. Serves as a resource and liaison between the charging departments, billing/PFS, HIM and the management team.
11. Facilitates a positive working relationship with physicians, nurses, and medical staff and hospital employees to ensure that all work-related encounters are productive.
12. Resolve accounts in assigned work queues timely.
13. Maintain positive working relationships with staff, other key contacts, and management team.
14. Responsible for timely completing special projects and/or audits as assigned by management and seeks advice and guidance as necessary to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.
