POSITION SUMMARY:

Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.

Position: Physician Practice Coder

Department: BUMG Corporate PBO General

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Coding support
• Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures. Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems. Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. Consults with the CDCI team to request appropriate physician or appropriate medical staff to clarify medical record information.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
• Utilizes hospital’s cultural values as the basis for decision making and to facilitate the hospital’s goals and mission.
• Follows established Hospital infection control and safety procedures.
• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Perform random chart audits.
• Provide continual coding updates.
• Research coding issues that arise.
• Codes diagnoses and procedures from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Reviews charts for documentation and signature.
• Performs other duties as needed.
• Must adhere to all of BMC’s RESPECT behavioral standards.

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CPC/CCS – Certified Professional Coder

EXPERIENCE:

2-5 years experience required in a multi-specialty physician coding environment to include coding, compliance, and billing processes.

KNOWLEDGE AND SKILLS:

• Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Work also requires basic concepts of human anatomy, physiology and pathology.
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail.
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
• Reviews and analyzes coding-related claim denials to determine the underlying cause, including incorrect CPT, ICD-10-CM, modifier, sequencing, medical necessity, documentation, or charge capture issues.
• Performs detailed review of denied claims, physician medical records, charge sessions, payer information, and applicable coding guidelines to determine whether the claim was coded and billed appropriately.
• Identifies trends and recurring denial patterns and performs root cause analysis to determine opportunities for coding, documentation, workflow, or system improvements.
• Determines appropriate coding corrections and recommends resolution of coding-related denials in accordance with CPT, ICD-10-CM, payer, Medicare, Medicaid, and other applicable guidelines.

Compensation Range:

$24.04- $33.65

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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