Certified Professional Coder - Manning - Coding

Salary: $19.33 - $26.58 per hour, depending on qualifications

Schedule: Monday through Friday, 8am to 5pm

JOB PURPOSE:

The Certified Professional Coder coordinates and performs the implementation of concurrent coding and querying processes, as well as performing administrative and fiscal duties, tasks, and assignments in support of the Business Office Department and its varied operations.  A Certified Professional Coder is responsible for the translation of healthcare providers’ diagnostic and procedural phrases into coded form, as well as the review and interpretation of health record documentation to ensure accurate coding services are rendered and submitted.  A Certified Professional Coder ensures that all technical aspects of the assignment of diagnostic and procedural coding are carried out in accordance with established standards and comply with CMS, NCQA, third-party payers, and other regulatory agencies.  The incumbent will support and assist in the training and education of Coding Assistants in the use of organizational software applications, which support and facilitate concurrent coding.  Performing the functions and requirements for this position follows standardized procedures and policies requiring limited judgment in their execution and will always remain within the defined scope for the position. 

An employee in this position works with general supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are presented to the supervisor for resolution. 

Essential Job Functions:

• Performs administrative, technical, and fiscal duties, tasks, and assignments supporting Business Office operations within established periods; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
• Maintains at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as generally accepted confidentiality standards.
• Performs the specialized technical skills to complete all assigned coding processing duties, tasks, and responsibilities, in addition to working successfully with all organizational operating systems, and/or business software, such as:
  • Reviews complex medical records and accurately codes the primary/secondary diagnoses and procedures using ICD and/or CPT coding conventions;
    • Analyzes provider documentation to assure the appropriate Evaluation and Management levels are assigned using the correct CPT code;
    • Identifies incomplete documentation in the medical record and formulate a provider query to obtain missing documentation and/or clarification and provide education to providers to accurately complete the coding process;
    • Reviews records for compliance with established third-party reimbursement agencies and special screening criteria;
  • Utilizes standard coding guidelines, principles and coding standards to assign the appropriate ICD and CPT codes for all record types ensuring accurate reimbursement;
  • Contacts providers or clients as appropriate when documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes;
  • Reviews all coding entries for accuracy and completeness prior to submission to billing system;
  • Collaborates with staff on resolution of outstanding appeals pending with insurance payers in order to expedite resolution of accounts.
• Provides support and instruction to internal clients regarding financial reimbursement, evaluation of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) coding, supporting improvement in provider documentation, coding and other regulatory compliance for commercial and managed care payers; as well as reimbursement methodologies.
  • Provides real-time feedback to providers as it pertains to: proper coding and clinical documentation of services performed, coding issues, and reviewing denials;
  • Evaluates and identifies front-end and back-end error trends for training utilization, bringing them to the attention of the supervisor.
• Coordinates the work of designated Coding Assistants ensuring the quality and quantity of work-performed meets the established departmental and organizational standards through regular audits. 
• Demonstrates an understanding of and proficiency with the application of all Joint Commission Accreditation standards and reporting requirements applicable to a Certified Professional Coder.
• Communicates and coordinates successfully with providers and other internal clients regarding coding documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
• Embraces and supports a professional working environment based upon an understanding and respect for diversity and multi-culture in all its forms; demonstrates sensitivity, acknowledges varied beliefs, attitudes, behaviors, and customs;  and encourages communication and appreciation of all forms of diversity.
• Demonstrates an exceptional level of customer service; answering and responding to all incoming calls, emails, and inquiries in a timely and effective manner, responds to requests for support providing general information in response to inquiries; referring technical inquiries or complaints to the appropriate department member for resolution.
  • Exemplifies “World Class” customer service experience working to resolve complaints and living the mission, vision, and values of the organization.
• Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, or patients, successfully conveying and exchanging information in a positive and effective manner.
• In support of the Mission and Vision of El Rio Community Health Center, when associated with and/or identifiable as an employee of El Rio Community Health Center employees will at all times represent themselves as a professional role model of El Rio, serving as a positive informational resource for members of the organization and community.
• Support El Rio by participating in community events that promote good health and which contribute to a broader awareness and understanding of El Rio Community Health Center and the many services provided to the community.
• Ensures accurate information is maintained for patient accounts and payer balances by posting third party and patient payments, adjustments/denials, and reclassifying charges to correct payers.
• Ensures and supports the cost effective use of materials, supplies, and equipment by limiting waste of all organizational supplies and resources.
• Gains and maintains an intermediate understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD and CPT coding guidelines to outpatient diagnoses and procedures.
• Gains and maintains an intermediate understanding of applicable Federal, State, and commercial payer requirements, standards, regulations or laws; as well as all organizational policies and procedures related to healthcare billing and payment processing.
  • To include, the standards and requirements for commercial and managed care insurance governmental regulations; and commercial or managed care insurance guidelines regarding billing, documentation and compliance.
• Attends and participates in conferences, workshops, and other training opportunities related to receivables coding, and corporate compliance standards or regulations.

Minimum Education and Experience:

• A High School Diploma or G.E.D.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations:

• Must possess and maintain a current Certified Professional Coding certification (CPC).

• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday.  If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

El Rio Health is a diverse and inclusive organization. We are invested in helping you and your family Create Tomorrow.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

El Rio Health requires all employees (except those 100% working remotely) to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire.

All employees are strongly recommended to obtain COVID 19 and maintain vaccination status (i.e. as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Personnel who decline to receive COVID 19 and/or flu vaccination per most recent CDC recommendations will be recommended to wear a facemask while in an El Rio Health facility, including both clinical and non-clinical areas from November 1 to April 30 (subject to change depending on viral activity). Subject to exemptions and accommodations when required by law.

All employees are required to undergo drug testing prior to employment and, will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.