Medical Coding - Baystate Health

Req#: R20021
Category(s): Information Technology/Health Information Management, Medical Coding
Full Time / Part Time: Full-Time
Shift: First

Coding Specialist Senior – PBO

Summary Description: 

One to three paragraphs describing job function.  In addition to job qualifications this will be used for posting.  This section should include tie to line of sight and employee engagement – how this job relates to our vision and mission.  (Do not use bulleted text.)

The Coding Specialist Senior – Physician Billing Office is responsible for accurate coding of complex surgical, procedural, diagnostic and determining appropriate levels of evaluation/management services for inpatient, outpatient, and emergency medicine charges  while adhering to all coding and governmental/carrier guidelines. All tasks need to be performed following the Operating Principles of Baystate Health.

Adheres to system and department compliance policies, and any and all applicable laws and regulations. Performs other duties as assigned.

Job Requirements:    
Expansion of the summary description.  Specific job related responsibilities that will be used to measure performance.  Please check which job responsibilities are “Essential Functions” as defined by the Americans With Disability Act. View ADA Requirements

1) Mastered proficiency in all essential functions of the Coding Specialist position.

2) Expertise in coding the most complex clinical areas including but not limited to Neurosurgery, Trauma Surgery, Cardiovascular Surgery, Vascular Surgery, Interventional Radiology and determine levels of evaluation and management services though in-depth chart review of clinical documentation and active engagement with providers to clarify procedures and documentation to ensure compliant maximization of revenue.

3) Proficiency in coding complex office, outpatient and inpatient charges including but not limited to Surgical ICU and Vascular Surgery; requires chart review and active engagement with providers to determine procedures performed and diagnoses; cross-trained in all clinical areas.

4) Identification and documentation of missing provider charges and billing issues accurately and timely maintained on logs escalated to executive leadership.

5) Reviews daily and weekly reports, clears edits and identifies potential issues; works collaboratively with Compliance and management to resolve.

6) Active participation in provider face-to-face training and problem resolution meetings to provide insight into issues, make suggestions for improvements and develop close working relationships with the providers; assist in the education of providers.

7) Mentorship of all new and existing Coding Specialists and Coding Associates.

8) Maintains the highest levels of confidentiality at all times.

9) Create and maintain documentation for coding processes throughout the department to ensure consistency of all work performed as needed.

10) Meets, exceeds and sustains a 95% accuracy rate for quality and productivity as determined by department policy.

11) Assists with special projects and tasks as assigned by Coding Lead, Supervisor, Educator, Manager and/or Director.

12) Active participation in group activities; actively engaged and guides others through positive interactions; leads by example.

Qualifications

Unless otherwise required by certification, licensure, or registration, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the minimally required education and/or experience listed in the Qualifications section below.

Minimally Required Education: If none required select “none required”.

High School / GED

Preferred Education:  

Graduate of a certified Coding Program

Minimally Required Experience: If none required select “none required”.

Four or more years experience as a coder in a provider-based setting with two or more years experience in coding complex surgical services with in-depth review and extrapolation from procedure and operative notes.

A pre-employment Assessment for new hires must be completed with demonstrated knowledge and experience in the inpatient/outpatient coding.

Preferred Experience:

Four or more years experience in coding provider-based surgical services in a multi-specialty surgical practice with in-depth review and extrapolation from procedure and operative notes.

Ability to review and accurately level evaluation and management services.

Skills and Competencies: 

This position is for those with robust experience in coding complex surgical, procedural, diagnostic and determining appropriate levels of evaluation/management services for inpatient, outpatient, and emergency medicine charges while adhering to all coding and governmental/carrier guidelines. Requires graduating from an accredited coding program and certification with either a CPC or CCA certification.

Thorough knowledge of medical terminology

Advanced knowledge of ICD-10-CM codes, CPT codes, CCI, as appropriate

Passed the Baystate Health coding assessment

Knowledge and experience with Microsoft Windows programs

Abbreviations used in this job description.:

CPC Certification = Certified Professional Coder (AAPC)

CCA Certification = Certified Coding Associate (AHIMA)

CCS Certification – Certified Coding Specialist (AHIMA)

CCS-P Certification – Certified Coding Specialist Physician Based (AHIMA)

ICD-10-CM = International Classification of Diseases 10th revision, Clinical Modification

CPT Codes = Current Procedural Terminology

CCI = Medicare Correct Coding Initiative

Certification:

Certification of one or more CPC,or CCS-P, CCS (Required)

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Certifications:

Certified Coding Associate – American Health Information Management Association, Certified Coding Specialist – American Health Information Management Association, Certified Coding Specialist Physician Based – American Health Information Management Association, Certified Professional Coder – American Academy of Professional Coders

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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