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ProFee Coder

Company: St Luke's University Health Network
Location: Allentown
Posted on: June 9, 2021

Job Description:

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

Under the direction of the Coding Manager, the ProFee Coder is responsible for the assignment of codes to the professional fee services in the hospital setting according to ICD10, CPT and HCPCS basic coding rules and principles to support and play a key role in the revenue cycle process for SLPG.

  1. Abstract and assigns the appropriate ICD10, HCPCS/CPT codes for all diagnosis and procedure professional fee services performed in outpatient and inpatient settings while following CMS guidelines. Utilizes 3M encoder for validation of RVUs and CPT procedure bundling.

  2. Responsible for maintaining up-to-date knowledge of coding guidelines as they relate to physician services for hospital inpatient, observation, consultant, surgical, critical care, and E & M services.

  3. Maintains an average 2 day lag in assigned coding charge review WQ.

  4. Maintains a 95% coding accuracy rate as measured through quality reviews.

  5. Meet production standard expectations as set by the department.

  6. Resolve medical record documentation deficiencies through healthcare provider query, and provide routine feedback to healthcare providers to correct deficiencies.

  7. Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured. Timely notification to education team to review documentation trends impacting revenue.

  8. Exercises good judgement in escalating identified coding trends that may negatively impact productivity, quality or revenue to mitigate claim denials. Maximize opportunities to enhance front end, coding-related claim edits to facilitate first pass resolution.

  9. Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all of the assigned services.

  10. Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information.

  11. Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.

OTHER FUNCTIONS:

  1. Responsible for monthly accountability report

  2. Assists in training of new personnel.

  3. Other related duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS: Sitting for up to seven hours per day, three- four at a time. Frequently uses fingers for typing, data entry, etc. Frequent use of hands. Use of upper extremities to rarely lift up to ten pounds. Rarely stoops, bends, or reaches above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general vision, near vision, peripheral vision and visual monotony.

POTENTIAL ON-THE-JOB RISKS: None identified.

Identified Risks, None Identified and/or Fit Tested Statement Which States That:

Employees who work in patient care areas where they may have potential exposure to patients with suspected or proven tuberculosis (TB) must have the ability to wear a particulate respirator and be fit-tested in compliance with the current recommendations from the CDC (enforced by OSHA) or must provide physician documentation as to the inability to wear a particulate respirator.

SPECIFIC PROTECTIVE EQUIPMENT AVAILABLE:

MOST COMPLEX DUTY: Ability to code physician/patient encounters by appropriately assigning diagnosis and procedure codes for accurate reimbursement. Knowledge of coding guidelines and Third Party documentation requirements. Understanding of E & M codes, surgical/procedure codes and requirements for coding. Ability to utilize multiple hospital programs simultaneously to complete assignments. Also, the ability to deal with providers and office staff in a tactful, but decisive manner.

SUPERVISION (RECEIVED BY AND/OR GIVEN TO): Reports to Manager of Physician Coding Service. Supervision as required.

COMMUNICATIONS: Must communicate frequently with physicians/AP's and office staff in a tactful, diplomatic, and decisive manner.

ADDITIONAL REQUIREMENTS: Adheres to the confidentiality guidelines as outlined within the Hospital and departmental policies. Promotes positive customer satisfaction by way of prompt and courteous service.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.

Keywords: St Luke's University Health Network, Allentown , ProFee Coder, Other , Allentown, Pennsylvania

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