Prebill Inpatient Coding Specialist REMOTE

Major Responsibilities:
Edit and correct or coordinate the correction/review of edits generated on the 3M OCE/EAPG report.
1)Based upon a daily review of the OCE/EAPG report, review alert against patient record to determine the appropriateness of corrections to patient's accounts.

2)Make revisions with the utmost attention to accuracy to ensure correct claim generation.

3)Demonstrate and maintain proficiency in what constitutes an appropriate correction to a patient's account, the appropriate party to make the correction, and the data which substantiates a correction.

4)Document activities in a clean and concise manner in the Allegra system.

5)Responsible for the filing, security, confidentiality, retention and storage of all government and private documents initiated in unit.

Combine accounts according to payer requirements when appropriate.
1)Correctly identify when accounts are related or unrelated services by reviewing the clinical data contained in the patient's medical record.

2)Review and combine accounts in a timely manner, specifically, prior to the generation of the claim.

3)Demonstrate and maintain proficiency in properly combining accounts and/or charges according to payer policies and regulations.

Contacts physicians and other health care professionals and hospital department representatives to obtain needed information required for the correct assignment of CPT-4/HCPCS, modifiers and charges for outpatient services.

Other duties as assigned by SRCO/Billing Management
1)Responsible to read and understand all Advocate SRCO policies and departmental collections policies and procedures.

2)Maintains knowledge of HIPAA regulations within the scope of the position and carry out job duties in a manner consistent with these regulations ensuring action is taken within guidelines set forth.

3)Review and combine accounts in a timely manner, specifically, prior to the generation of the claim.

4)Must attend and participate in and understand information presented at department meetings.

5)Directs all questions or needs for clarification to management to ensure training needs are readily identified and addressed.

6)Identifies and makes recommendations for process improvements.

7)Responsible to read and understand all correspondence from Government Regulatory Agencies, Payer Updates, etc.

8)Keeps abreast of all system requirements and changes. Achieves proficiency in all applicable functions of the patient accounting systems.

9)Assists in completing ad hoc projects and related job activities as assigned to support department operations. During periods of high volume and/or impending deadlines, assignments may include assisting with patient accounting activities and functions typically performed by other SRCO positions.

Maintains current knowledge of ICD-CM and CPT/HCPCS coding systems, as well as APCs and other outpatient reimbursement methodologies and maintains coding credential certification and maintains HIM and/or coding certification credential with AHIMA
1)Attends internal and external educational seminars and inservices to satisfy continuing education requirements and maintain certification.

2)Reviews the periodicals provided to remain abreast of changes that will affect coding and reimbursement methodologies.

3)Participates in peer review activities to assess coding and abstracting accuracy.

Responsible for personal and professional growth and development.
1)Seeks assignments and special projects to facilitate growth towards potential advancement.

2)Keeps abreast of current practices via literature, educational offerings, professional affiliations, etc.

3)Acquires and maintains knowledge of all insurance regulations, local, state, and federal legislation and regulatory agencies and activities which may affect SRCO operations.

Education/Experience Required:

• Certified Coding Specialist (CCS) credential for inpatient or outpatient coding positions or Certified Coding Specialist-Physician based (CCS-P) for outpatient coding positions.

• Completion of coding certificate program from recognized community college (typically 20 semester hours of college credit courses) or significant coding experience prior to earning CCS or CCS-P credential. –OR—

• Registered Health Information Technician (RHIT) with associate’s degree in health information technology from accredited program or Registered Health Information Administrator (RHIA) with bachelor’s degree in health information administration from accredited program–AND– -3-5 years of recent acute care hospital outpatient coding experience

• Experience with the 3M OCE report or experience in charge capture determination in a complex department such as the emergency department. -Achieve satisfactory score on Advocate’s coding test.

Knowledge, Skills & Abilities Required:

• CCS, CCS-P, RHIT/RHIA
• Attention to detail (such as interpretation of clinical data including medical terminology and disease processes).
• Analytical skills for abstracting of clinical data. Ability to interpret regulatory and payer rules and directives concerning coding. Computer experience

Physical Requirements and Working Conditions:

• Ability to listen to and understand information and ideas presented verbally and in writing.
• Consistently exercises critical thinking skills or uses logic and reasoning to assess and resolve problems.
• Quickly makes sense of, combines and organizes information. • Consistently maintains a professional and approachable demeanor.
• Able to work under pressure and meet stringent deadlines in a fast-paced environment.
• Able to work independently.
• Pays strong attention to details and maintains high degree of accuracy
• Successfully alternates between two or more activities or sources of information.
• Accepts responsibility and maintains high level of accountability
• Strong collaboration skills.
• Available to respond to patient/third party requests during scheduled shift.
• Ability to work on a computer for extended periods of time.
• Ability to speak on phone throughout a daily assigned shift (with opportunity to alternate between sitting and standing if necessary).
• Ability to work effectively in an open floor environment.
• Lifting a minimum of 10 pounds.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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