This position supports Mercy's philosophy of patient centered care by administering medical payment policies and advising providers and coders on proper documentation for services, and providing quality assurance and education to coders on accurate coding. Will also be responsible for the timely and accurate coding of hospital services using ICD-10-CM and CPT/HCPCS classification systems for the purpose of reimbursement, research, and statistics in compliance with federal regulations.Job DutiesHandles medical necessity denial reduction based on documentation improvement to capture documentation requirements based on payor medical policy.Handles prior authorization denial reduction based on correct code selection for prior authorization, as well as same day verification of CPT codes post-procedure to validate correct procedure was authorized.Keeps current and reviews payor medical policies and creates provider and coder education related to them.Creates and conducts general provider education, at least three sessions annually.Creates and performs general coder education, monthly or as needed.Develops and conducts new provider education regarding E/M documentation guidelines, coding processes and specialty specific information as needed.Manages denial resolutions for assigned specialty area.Serves as Team Lead for coders within assigned specialties; monitors and reviews coding for accuracy and appropriateness.Performs other coding guidelines/duties as typical for Coder I-IV positions.Works independently within clinics to provide immediate education/queries to providers regarding scheduling/prior authorization issues.Knowledge, Skills and AbilitiesStrong knowledge of ICD-10-CM and CPT/HCPCS coding guidelines.Ability to read and interpret medical record documentation including lab and pharmacology data.Proficiency with Microsoft Office tools (Excel, Outlook, Word, PowerPoint).Strong computer background with basic typing and keyboarding skills.Excellent work prioritization skills needed.Ability to work independently with frequent interruptions.Excellent interpersonal communication skills (verbal, non-verbal, listening, and written) for all levels of staff (subordinate, peer, management, providers) and the ability to adapt communication style based on recipient.Working knowledge of hospital payment systems and federal and state regulations related to coding, billing, and compliance.Very strong knowledge of Evaluation and Management documentation guidelines (1195/97 and 2021) and ability to audit a medical record.Awareness of and skilled in navigating CMS and other payor websites and policies.Ability to collect and analyze data for trending.Ability to identify bottlenecks and refine processes.Professional ExperienceRequired:Minimum seven years previous coding experience required.Preferred:Previous supervisory, audit or QA experience preferred.EducationPreferred:Associate of Applied Science degree, Bachelor's degree in Health Information Technology or related field, or completion of coding certificate program preferred.Licensure, Certification, RegistrationAHIMA or AAPC coding certification (e.g. RHIT, RHIA, CCA, CCS, CCS-P, CPC) is required.One or more additional specialty coding certification within specialty group is required.Second specialty coding certification within specialty group required within 18 months of employment required.CCDS-O (certified clinical documentation specialist - outpatient) certification after 2 years of employment required.CEMA or CPMA certification within 1 year of employment required.Physical Demand RequirementsSedentary: Exert up to 10lbs. of force occasionally and/or a minute amount frequently.
