JOB SUMMARY

Responsible for validating/reviewing and assigning applicable CPT, ICD-10, Modifiers and HCPCS codes for inpatient, outpatient and physicians office/clinic settings. Adheres to all coding and compliance guidelines. Maintains knowledge of coding/billing updates and payer specific coding guidelines for multi-specialty medical practice(s). Communicates with providers and team members regarding coding issues.

MINIMUM REQUIREMENTS

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred
• Experience - Two (2) years professional coding experience

KNOWLEDGE, SKILLS AND ABILITIES

• Maintains knowledge of governmental and commercial payer guidelines.
• Participates in coding educational opportunities (webinars, in house training, etc.).
• Ability to utilizes appropriate coding software and coding resources in order to determine correct codes.
• Knowledge of office equipment (fax/copier)
• Proficient computer skills including word processing, spreadsheets, database
• Data entry skills
• Mathematical skills

ESSENTIAL FUNCTIONS

• All team members are expected to be knowledgeable and compliant with Prisma Health’s values: Inspire health. Serve with compassion. Be the difference.
• Validates/reviews codes for assigned provider(s)/Division(s) based on medical record documentation. Adheres to all coding and compliance guidelines.
• Responsible for resolving all assigned pre-billing edits
• Communicates billing related issues and participates in meetings to improve overall billing process
• Provides feedback to providers in order to clarify and resolve coding concerns.
• Assists in identifying areas that need additional training.
• Performs other duties as assigned.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

• This is a non-management job that will report to a supervisor, manager, director or executive.