Ambulatory Professional Fee and Hospitalist Coder (Full Time)

At Northbay Health, the Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner in the hospital setting. Our ideal candidate is a dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Abstracts demographic and physician data to meet both internal and regulatory requirements for reporting utilizing the hospital’s abstracting system. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines.

Primary Job Duties

• Independently performs coding of patients’ inpatient records to ensure accurate assignment of physician, professional fee, surgical, and other hospital-based services using the most appropriate CPT, ICD-10, and HCPCS codes in accordance with CMS, Coding Clinic, and other regulatory guidelines. Adds modifiers as appropriate to maximize reimbursement and reduce denials.
• Must have experience working in a multi-specialty environment and assigning physician Evaluation and Management (E&M) levels.
• Collects visit information, analyzes documentation, identifies discrepancies, and queries providers as needed to ensure the accuracy and integrity of reviewed data.
• Utilizes the electronic health record (EHR), abstracting systems, encoding systems, and computer-assisted coding systems to perform job responsibilities.
• Ensures coding is accurate and sequenced correctly in compliance with coding guidelines, government regulations, and payer requirements.
• Maintains current knowledge of coding requirements and compliance guidelines based on assigned specialty and departmental needs.
• Meets department productivity and quality standards for coding performance.
• Abstracts designated demographic data into the medical record abstracting system to satisfy internal and external regulatory reporting requirements.
• Provides documentation education and support to physicians to ensure coding assignments comply with regulatory requirements.
• Collaborates with the Clinical Documentation Integrity (CDI) program as needed.
• Responds to audit reviews and addresses findings in a timely manner.
• Provides timely feedback to the Manager, Professional Fee Coding, regarding operational issues and escalates recurring concerns as appropriate.
• Partners with Business Office staff to resolve billing and coding issues and corrects pending diagnoses or suspended reports as needed.
• Keeps management and applicable departments informed regarding completed work, backlogs, physician education activities, and other assigned responsibilities through designated tracking tools.
• Maintains required coding certification and pursues ongoing professional development through educational programs, seminars, and related learning opportunities.
• Adheres to HIPAA policies and procedures to maintain patient confidentiality and protect all health information.
• Complies with organizational policies and procedures, safety standards, Joint Commission (TJC) standards, and all applicable regulatory requirements.
• Demonstrates the True North Values of Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
• Reports to the office as required and understands that failure to meet regulatory accuracy standards may result in a return to an in-office work environment.
• Performs other duties and responsibilities as assigned.

Education

• High School Graduate or equivalent preferred.

Licensure

• Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

Experience

• Five or more years of continuous experience in Multi-specialty Profee Hospital and clinical coding required.
• EMR Medical records experience is required.
• Experience with an encoder system preferred.
• Comprehensive knowledge and application of profee E&M guidelines for physician inpatient coding and billing.
• Demonstrated knowledge of anatomy and physiology, medical terminology, disease process, reimbursement methodologies (DRGs, HCCs, APCs), and the conventions, rules and guidelines for current coding classification (ICD10-CM, CPT and HCPCS).
• Demonstrated understanding of the clinical content of a health record.
• Knowledge of and experience with PC’s, Cerner, and/or computer systems and programs highly desired.
• Microsoft Office: Email, Word, Excel.
• Has a comprehensive understanding of insurance requirements and compliance guidelines for Medicare, PHP, WHA and Medi-Cal, Worker’s Compensation, Commercial Insurances.
• Ability and self-discipline to be able to work remotely.
• Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements.
• The ability to work independently as well as in a team environment.

Skills

• Ability and desire to hit metrics upon training (idle time is also monitored on this hourly paid position).
• Technically savvy (ability to learn software and troubleshoot equipment as needed).

Standards of Performance

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

• Attendance is an essential function of the job.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to sit for long periods of time.
• Ability to lift, push or pull 5 pounds.
• Occasional bending, stooping, crouching, reaching.
• Ability to concentrate and maintain accuracy despite frequent interruptions.
• Keyboarding skills.

Hours of Work

• Full Time Days Monday through Friday as assigned based on business need.
• Timing may also be at discretion of leadership based on business need.

Other Requirements

• Must have a private, distraction-free area in your home for working (HIPAA reasons).
• Web-cam training will be used frequently for team engagement.
• Internet Requirements: Must have high speed internet.
• Please test your internet prior to applying to make sure you are over 125 mbps download speed or be willing to upgrade upon an offer.