[Hiring] Prof Coding Spec II Edits and Denials @WVU Medicine

Role Description

To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospital and outside agency requirements. This includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record. This position is an integral part of an overall compliance program effort as it pertains to physician coding and billing functions, as such will interact with physician and non-physician providers to maximize correct coding initiatives. Responsible for analyzing and resolving issues of missing charges and problem accounts by researching information regarding department reimbursement.

Qualifications

• High School Diploma or Equivalent.
• Current HIM/Coding Certification through one of the following:
  • American Health Information Management Association (AHIMA)
  • American Academy of Professional Coders (AAPC)
• Two (2) years of medical coding experience.

Requirements

• Two (2) years of physician office coding experience.

Core Duties and Responsibilities

• Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified.
• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
• Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
• Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
• Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.
• Monitors on an ongoing basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.
• Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

Physical Requirements

• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within the normal range.
• Must have manual dexterity needed to operate computer and office equipment.
• Must be able to lift, push or pull 10-20 pounds.

Working Environment

• Standard office environment.
• Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
• May require travel.

Skills and Abilities

• Must be able to concentrate and maintain accuracy during constant interruptions.
• Must possess independent decision-making ability.
• Must possess the ability to prioritize job duties.
• Must be able to handle high stress situations.
• Must be able to adapt to changes in the workplace.
• Must be able to organize and complete assigned tasks.
• Must possess excellent written and verbal communication skills.
• Must meet quality and productivity standards.
• Must possess the knowledge of anatomy, physiology and medical terminology.

Additional Job Description

• Scheduled Weekly Hours: 40
• Shift: Exempt/Non-Exempt: United States of America (Non-Exempt)
• Company: SYSTEM West Virginia University Health System
• Cost Center: 539 SYSTEM HIM Provider Based Coding Analysis