Job Description

Position: Appeals Coder

Duration: 6-Month Contract-to-Hire

Start Date: ASAP

Location: ONSITE in Louisville, KY

Hours: M-F, 8am-5pm, 40 hours per week

Equipment: Will be provided

Requirements:

• High School education or GED required.
• Must have and maintain Certified Professional Coder (CPC) certification through AAPC or must have and maintain CCA, CCS or CCS-P certification through AHIMA.
• Three years direct coding experience and in-depth Coding and HIPAA regulations for physician offices, preferred.
• Ongoing coding guideline knowledge is required
• Advance knowledge of medical terminology, abbreviations, techniques and surgical procedures
• Advance knowledge of medical codes involving selections of most accurate and description code using the ICD-9-CM, ICD-10-CM, CPT, HCPCS, and IHS coding conventions.
• Advance knowledge of medical codes involving selection of most accurate and descriptive code using the CPT codes for billing of third-party resources
• Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-9-CM, ICD-10-CM code
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data
• Strict compliance with all coding guidelines at all times.
• Working in a highly accurate and yet efficient manner.
• Strict attention to detail in both coding and EMR entries.

Responsibilities:

Coding (60% Weight)

• Obtain copies of chart notes, reports, electronic medical records, and any other necessary records for purpose of review
• Comply and communicate deficiencies that impact the billing process.
• Review documentation needed to clarify or complete the information required for compliant coding and billing of services performed.
• Abstract patient evaluation and management services, including consultations, and bedside procedures for the purpose of selection of the appropriate HCPCS code(s), ICD-9 code(s), and modifier(s)
• Follow production and quality standards for coders as established.

Compliance (20% Weight)

• Ensure that documentation meets the Teaching Physician Rules as mandated by CMS and ULP policies prior to release of a code for billing
• Ensure that documentation for Advanced Practice Providers meets the payer specific rules prior to release of a code for billing

Communication/Education (10% Weight)

• Develop daily/weekly communication with providers.
• Provide comments/suggestions relative to weak areas identified in the coding reviews.
• Provide trending deficiencies to CBO Manager and Compliance Educator as appropriate.
• Responds in a timely manner to questions from providers, department representatives.
• Maintain compliance with rules and regulations regarding coding.
• Constant reviews of incoming Fee Tickets to ensure compliance standards are met.
• Ability to work within a team environment and meet monthly goals.
• Other duties as assigned.

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