Surgical Coder

Summary

This position is primarily responsible for overseeing that all procedures are coded correctly and documented in the surgeon’s notes according to AMA, ICD-10, and NCCI coding guidelines while maximizing payment. The Coder is responsible for gathering, verifying and entering into our PM system (EPIC) all scheduled surgical procedures and all outside encounters performed at associated facilities. Responsibilities also include correcting billing information according to insurance guidelines, including all insurance, Medicare, Workers Comp, MVA and Third party carriers. The Coder will communicate with provider coding discrepancies and provide accurate answers and documentation to the physicians when responding or addressing their coding questions or issues.

Responsibilities

• Reviews all procedure and diagnosis codes submitted by provider for accuracy and maximum reimbursement against the documentation and according to AMA, ICD-10, NCCI and AAOS coding guidelines. Should a provider not submit the suggested CPT and/or ICD-10 codes, the Coder is responsible for determining code selection according to AMA, ICD-10, NCCI and AAOS coding guidelines.
• Coder needs to utilize the AAPC Codify tool to determine bundling guidelines and assistant payable status in addition to NCCI edit tools as established in EPIC/current PM system.
• Researches and communicates code changes to physicians via send back in basket message in EPIC/current PM system. Provides physicians with specific examples and appropriate references to support recommended coding changes.
• Verifies all codes against coding edits in EPIC/current PM system including NCCI bundling edits, payor specific requirement edits, modifier usage edits and any edit that is showing as needing review via an Error or Warning in the charge review data.
• Ensures all charges are posted and linked to the correct insurance set in EPIC/current PM system.
• Completes surgical and outside encounters that are ready to code or noted to have the appropriate operative report available with the established TAT of three business days.
• Runs the scheduled surgery report in the PM system daily to capture and review all scheduled surgical cases for assigned providers. Coder is responsible for updating reports when applicable. Coder is responsible for awareness of the volume of claims to ensure reports continue to show appropriate encounters. Coder is responsible for escalating any reporting issue to their management team.
• Runs the outside encounter report in the PM system daily to capture and review all unscheduled visits to include hospital consultations, subsequent hospital visits, and unscheduled surgical cases for assigned providers. Coder is responsible for awareness of the volume of claims to ensure reports continue to show appropriate encounters. Coder is responsible for escalating any reporting issue to their management team.
• Maintains current workflow and investigates problem accounts. Informs management when information is consistently missing or otherwise unavailable.
• Reviews documentation including proper provider signatures, proper locations, proper date of service, proper provider and/or assistants and bills accordingly.
• Coder reviews procedure authorization for accuracy. If a CPT code that is billable but not found on authorization, a send back to site is required for them to obtain a retro authorization. Claim is still to be released and not wait for retro to be obtained, however.
• Coder is responsible for reaching out to provider and/or provider site contact to communicate any missing documentation that is not compliant. Claim is not to be billed until documentation is found to be corrected by provider and/or site and found to be compliant.
• Prepares and submits additional documentation for billing of unlisted codes including verifying comparable code and placing appropriate detail in Box 19 of HCFA for reference of payor.
• Assists coding department, RCM and/or IBJI site staff with any coding questions.
• Monitors end user productivity report in PM system to ensure productivity is reflected accurately on a daily basis. Any work and/or time spent outside of the EPIC/current PM system is to be reported on the coder's time management spreadsheet to ensure time punched in according to TimePro is accurate.
• Coder is responsible for working surgical/outside encounter denials as assigned on the weekly denial schedule.
• Coder is responsible for attending scheduled meetings via Google meet or in person when required. This may require the camera to be on at times.
• Coder is responsible for responding to emails and Google chats within a timely manner.
• Coder is responsible for any other duties assigned by management.

Other Responsibilities

• Adheres to and supports the objectives, policies and procedures of Illinois Bone and Joint Institute.
• Supports the development and implementation of improvement initiatives as it relates to the department goals.
• Maintains confidentiality and patient information according to HIPPA guidelines.
• Adheres to policy and procedures according to the Illinois Bone and Joint Employee Handbook.
• Maintains issued equipment and supplies. Reports any issues to appropriate management and/or IT team to resolve any issues immediately.
• Maintains their coding certification and submits to management proof when certification renews or changes.

Education/Training Requirements

• High school diploma or GED.
• Must have Physician Coding Credentials from AAPC or AHIMA.
• Three years minimum experience in coding for orthopedic surgery subspecialties preferred.
• Knowledge of coding guidelines following AMA, ICD-10, NCCI and AAOS.
• Must be able to exercise independent judgment and react appropriately in stressful situations.
• Skill in defining problems, collecting data and interpreting medical billing information.
• Skill in computer applications, email, zoom meetings, etc
• Excellent communication skills and analytical skills

Physical Requirements

• Requires sitting for a long period of time at your established workstation.
• Some bending and stretching is required.
• Working under stress and using the telephone is required.
• Manual dexterity required for use of computer keyboard and calculator.

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.