Provider Coding Specialist - Coding & Charge Capture
Company Name:
PeaceHealth
Req ID:
38481
About PeaceHealth
PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 800 physicians and providers, a comprehensive laboratory system, and nine medical centers serving both urban and rural communities throughout the Northwest. In 1890, Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues to serve communities when invited to do so with a spirit of collaboration and stewardship. This is The Spirit of Healing-The Spirit of PeaceHealth.
Department:
Coding & Charge Capture (7320)
JOB SUMMARY
This position is responsible for ensuring accurate and consistent procedural/diagnostic coding and documentation, timely and complete charge capture, and correction/resolution of insurance claim denials and patient disputes due to coding issues.
ESSENTIAL FUNCTIONS
1. 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.
2. 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.
3. 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.
4. 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.
5. Reviews claims denied due to coding issues and makes corrections/recommendations for corrections.
6. Assists providers and PFS billing/reimbursement staff with coding questions.
7. Researches coding/compliance issues utilizing regulatory and medical informational resources.
8. 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.
9. Assists in preparation and distribution of provider education materials and participates in provide/.staff individual group education presentations regarding coding issues.
10. Participates in departmental and cross-regional meetings and projects involving coding/billing and helps develop forms/process for use in clinics.
11. Maintains communication and relationships with PFS billing and reimbursement management and staff regarding issues affecting coding and charge capture.
12. Performs other duties as assigned.
QUALIFICATIONS
EDUCATION: High school diploma or equivalent required. Knowledge of anatomy, physiology, medical terminology, diseases, procedures and therapies.
EXPERIENCE/TRAINING:
o Minimum of one year's experience in physician professional coding in a medical care facility, billing office or medical records department.
LICENSE/CERTIFICATION:
o CPC (Certified Professional Coder) or CCS (Certified Coding Specialist -Physician Based) or preferred. If not currently certified, must obtain within one year of employment.
OTHER SKILLS:
o Proficiency in coding Professional Inpatient and/or Ambulatory Care, Emergency Department and Outpatient medical records with ICD-9 CM and CPT4 classification systems with expertise in one or more specialty area.
o Proficient in the use of MS Office applications including Excel and Word.
o Adept and proficient in windows based computer environment with respect to coding software systems.
o Good verbal and written communication skills
o Critical thinking and problem solving skills required.
o Familiarity with medical billing software and electronic medical record preferred.
At PeaceHealth, we carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way. The fulfillment of this Mission is our shared purpose. It drives all that we are and all that we do. Caregivers of PeaceHealth embrace the spirit of these words and share our commitment to Exceptional Medicine and Compassionate Care, and are willing to learn and grow as a member of the PeaceHealth family.
Disclaimer:
The above information on this description has been designed to indicate the general nature and level of work performed within this job class. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Location:
Stonemill - Central Billing Office (805)
Job Category
: IT/Health Information Management
Shift:
Day
Shift Length:
8 Hours
FTE:
1.0
Work Type:
Full Time
Salary range starts at
: $17.37
Required Certifications/Licensure
: Clinical Coding Specialist
The above information on this description has been designed to indicate the general nature and level of work performed within this job class. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Posting Notes: Vancouver, WA -- IT/Health Information Management -- Full Time -- PHMG ADMIN
Company Description:
As the premiere health care system in the Northwest, consistent with our mission and heritage, PeaceHealth is known for a healing culture that is patient-centered and family friendly. At PeaceHealth, the fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. To those who embrace the spirit of these words and our commitment to Exceptional Medicine and Compassionate Care, we offer the opportunity to learn and grow as a member of the PeaceHealth family. Join our team of caregivers who serve patients and their families to provide healing care for the mind, body and spirit.Estimated Salary: $20 to $28 per hour based on qualifications.
PeaceHealth
Req ID:
38481
About PeaceHealth
PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 800 physicians and providers, a comprehensive laboratory system, and nine medical centers serving both urban and rural communities throughout the Northwest. In 1890, Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues to serve communities when invited to do so with a spirit of collaboration and stewardship. This is The Spirit of Healing-The Spirit of PeaceHealth.
Department:
Coding & Charge Capture (7320)
JOB SUMMARY
This position is responsible for ensuring accurate and consistent procedural/diagnostic coding and documentation, timely and complete charge capture, and correction/resolution of insurance claim denials and patient disputes due to coding issues.
ESSENTIAL FUNCTIONS
1. 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.
2. 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.
3. 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.
4. 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.
5. Reviews claims denied due to coding issues and makes corrections/recommendations for corrections.
6. Assists providers and PFS billing/reimbursement staff with coding questions.
7. Researches coding/compliance issues utilizing regulatory and medical informational resources.
8. 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.
9. Assists in preparation and distribution of provider education materials and participates in provide/.staff individual group education presentations regarding coding issues.
10. Participates in departmental and cross-regional meetings and projects involving coding/billing and helps develop forms/process for use in clinics.
11. Maintains communication and relationships with PFS billing and reimbursement management and staff regarding issues affecting coding and charge capture.
12. Performs other duties as assigned.
QUALIFICATIONS
EDUCATION: High school diploma or equivalent required. Knowledge of anatomy, physiology, medical terminology, diseases, procedures and therapies.
EXPERIENCE/TRAINING:
o Minimum of one year's experience in physician professional coding in a medical care facility, billing office or medical records department.
LICENSE/CERTIFICATION:
o CPC (Certified Professional Coder) or CCS (Certified Coding Specialist -Physician Based) or preferred. If not currently certified, must obtain within one year of employment.
OTHER SKILLS:
o Proficiency in coding Professional Inpatient and/or Ambulatory Care, Emergency Department and Outpatient medical records with ICD-9 CM and CPT4 classification systems with expertise in one or more specialty area.
o Proficient in the use of MS Office applications including Excel and Word.
o Adept and proficient in windows based computer environment with respect to coding software systems.
o Good verbal and written communication skills
o Critical thinking and problem solving skills required.
o Familiarity with medical billing software and electronic medical record preferred.
At PeaceHealth, we carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way. The fulfillment of this Mission is our shared purpose. It drives all that we are and all that we do. Caregivers of PeaceHealth embrace the spirit of these words and share our commitment to Exceptional Medicine and Compassionate Care, and are willing to learn and grow as a member of the PeaceHealth family.
Disclaimer:
The above information on this description has been designed to indicate the general nature and level of work performed within this job class. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Location:
Stonemill - Central Billing Office (805)
Job Category
: IT/Health Information Management
Shift:
Day
Shift Length:
8 Hours
FTE:
1.0
Work Type:
Full Time
Salary range starts at
: $17.37
Required Certifications/Licensure
: Clinical Coding Specialist
The above information on this description has been designed to indicate the general nature and level of work performed within this job class. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Posting Notes: Vancouver, WA -- IT/Health Information Management -- Full Time -- PHMG ADMIN
Company Description:
As the premiere health care system in the Northwest, consistent with our mission and heritage, PeaceHealth is known for a healing culture that is patient-centered and family friendly. At PeaceHealth, the fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. To those who embrace the spirit of these words and our commitment to Exceptional Medicine and Compassionate Care, we offer the opportunity to learn and grow as a member of the PeaceHealth family. Join our team of caregivers who serve patients and their families to provide healing care for the mind, body and spirit.Estimated Salary: $20 to $28 per hour based on qualifications.
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