Professional Coder II

Hours: 40 hours per week - Monday through Friday. Location: 100% Remote Job Profile Summary This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Health Information Management duties: Responsible for the accuracy, maintenance, security, and confidentiality of patient's health information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation. Job Overview This position reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD-10, CPT, and HCPCS, modifier and/or other codes according to coding guidelines. Communicates effectively with providers and/or all appropriate staff regarding missing information such as CPT, ICD-10, and documentation issues, to ensure proper coding and reimbursement. Works with leadership to review denial and reimbursement reports for accuracy, as well as conducting audits to ensure documentation, code capture, and billing are accurate and precise. Performs pre and post visit chart audits to ensure proper code assignment. Job Description Minimum Qualifications: 1. High school diploma or equivalent. 2. Completion of medical coding certificate program. 3. Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT). 4. One (1) year of healthcare coding experience Preferred Qualifications: 1. Associates degree. 2. Two (2) years of coding experience within clinical specialty. Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned. 1. Verifies and abstracts specific clinical and demographic data from the patient record. 2. Performs pre-visit chart audits, and post encounter review to ensure coding accuracy and can determine medical records ensure codes reported are support by the documentation. 3. Assigns accurately Evaluation and Management (E&M) codes, ICD-10 diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers and quantities derived from medical record documentation (paper or electronic) for patient encounters. 4. Correlate information from various EMR systems supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate. 5. Reviews reports with leadership to identify reimbursement changes/discrepancies. 6. Reviews audit lists regarding coding/billing changes, as well as denial reports. 7. Identifies and evaluates coding issues, summarizes findings for leadership, makes recommendations for course of action. 8. Mentor coders and assist in training of new coders within the department. Identifies coding opportunities and issues, research for compliance, and educate providers and staff; Participates in creating of departmental policies and procedures related to the outpatient and ambulatory coding function. May be asked to provide input to coder performance appraisals. 9. Documents results of all special project work, and providing recommendations for revenue managing opportunities relating to special projects. 10. Performs related duties such as answering and routing telephone calls and receiving people requesting action or follow up to the designated patient account representative. 11. Attends meetings as necessary and participates on projects to ensure that all services are captured through codes, educate providers on how to properly document to support identified procedures, and cross train staff to ensure consistency. 12. Maintains good relationship with physicians, social workers, and office personnel to facilitate good communication in coding queries and to educate providers in relation to documentation requirements for services. Promote excellent customer service. Identify and communicate problems and/or opportunities to improve processes with appropriate department staff. 13. Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working groups achievement of goals, and to help foster a positive work environment Physical Requirements: 1. Frequent standing & walking, and lifting of 5-10 lbs. 2. Manual dexterity using fine hand manipulation to operate computer keyboard. 3. Ability to see computer screen and reports. 4. Frequent contact with physicians and their office staff, insurance representative, medical directors, department heads and administrative managers. Skills & Abilities: 1. Excellent organizational skills and able to balance working on multiple tasks and provide timely follow through. 2. Effective interpersonal and communication skills. 3. Ability to work under pressure and meet deadlines. 4. Ability to communicate verbally, by phone or in person, with third party payers and medical staff. 5. Ability to give written and oral presentations to staff. 6. Knowledge of Excel and basic computer skills. 7. Ability to prepare written reports for management. 8. Working knowledge of ICD-9-CM and CPT coding system, DRG, APG, payment systems, medical terminology, anatomy and physiology. Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at .

Created: 2024-10-20