Job Details

Sr. Professional Coder - Full Time, Days, REMOTE

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The Professional Coding Analyst II will be responsible for reviewing clinical documentation, assigning appropriate diagnosis, procedure, and in some cases level of service codes to resolveclaim edits and denials. Ensures clinical documentation supports the charges posted, following the American Medical Association (AMA), Medicare, and Commercial coding guidelines on claims. Communicates trends and issues to leadership for investigation and resolution.

This is a remote role working Monday-Friday, day shift hours.

Responsibilities

Reviews claims in assigned work queues in Cerner Revenue Cycle including CMG Review and Ambulatory Edit failure work items. Analyzes coding edits, reviews timeline notes, reviews clinical documentation, including provider orders, progress notes, surgical and test results thoroughly to interpret and ensure documentation supports the posted charges.

Determines appropriate action needed to resolve coding edits/issues and ensure clean claim submission.

Performs coding functions, including Current Procedure Terminology (CPT), International Classification of Diseases, tenth revision, Clinical Modification (ICD-10-CM), documentation review, and claim denial review. Applies appropriate modifiers.

Ensures charges/coding are in alignment with the American Medical Association (AMA), Medicare, and Commercial coding guidelines on all claims reviewed. Credits /updates charges and coding as needed.

Ensures queues are worked timely and efficiently.

Maintains productivity and accuracy requirements.

Reports coding concerns, trends, and issues to leadership for investigation and resolution.

Effectively communicates with clinical and billing staff to obtain and/or provide pertinent data to complete coding requirements for charge entry, claim submission and follow-up, or denial follow-up.

Other Functions

Responds to inquiries from Customer Service in a timely and efficient manner and makes needed updates to coding, charges, and claims to help ensure prompt resolution of patient concerns.

Maintains strict confidentiality of all information including patient data, Healthcare information, financial/operational, and employee/human resources.

Perform other duties as assigned.

Qualifications

Required Qualifications

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).

Minimum one year of professional coding experience.

Demonstrates working knowledge of third?party methodologies, various medical claim formats by passing competency assessment before hire.

Demonstrates proficiency in International Classification of Diseases, Tenth revision, Clinical Modification (ICD?10?CM) and Current Procedural Terminology (CPT) by passing competency assessment before hire.

Preferred Qualifications

Experience with automated Revenue Cycle Management systems.

Strong PC skills, including word processing and spreadsheets.

Must have the ability to learn and utilize custom systems and applications.

Strong problem?solving skills, analytical abilities, excellent interpersonal, verbal, and written communication skills.

Knowledge of billing and regulatory guidelines as related to charging and other revenue cycle processes and ability to assist clinical departments and/or physician practices with changes to their charging practices based on guidelines.

Knowledge of clinical documentation improvement processes.

Seniority level

Mid?Senior level

Employment type

Full?time

Job function

Engineering and Information Technology

Hospitals and Health Care