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OVERVIEW:
Reviews and analyzes medical coding documentation to identify and correct discrepancies, resolve pre-bill claim edits, and address complex billing issues and claim denials in accordance with AMA, CMS, and payer guidelines. Collaborates with departmental staff and other partners to provide coding education, research policy updates, and respond to coding review requests while maintaining extensive knowledge of Epic billing systems and professional, outpatient, and inpatient coding practices. Supports all coding functions at or above the Medical Coding 1 level while working collaboratively to achieve departmental productivity goals.
SCHEDULE: Full-Time, 40 hours per week
ESSENTIAL DUTIES AND RESPONSIBILITIES
Reviews, analyzes, and interprets documentation and identifies discrepancies between the code selection and the documentation; corrects them, and presents findings and education to the appropriate partner.
Resolves pre-bill claim edits from all areas and as identified by claims scrubbing software.
Maintains a close working relationship with departmental staff, frequently querying them and providing education when coding discrepancies arise.
Researches and provides education to all partners regarding CMS policies related to outpatient coding, inpatient coding, and professional fee coding, and presents findings to them.
Solves complex billing and claim denial issues related to coding by researching policies and guidelines.
Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA), the Center for Medicare & Medicaid Services (CMS) and contracted payers.
Has a thorough understanding of the differences between professional coding in a clinic setting as compared to professional coding in a hospital setting (outpatient and inpatient), and demonstrates a high skill level in the practical application of that knowledge.
Maintains an in-depth knowledge of Epic billing, ambulatory, and hospital modules.
Responds to customer concerns through coding reviews requested by other departments.
Assists with all coding functions at or above the level of a Medical Coding 1 job description.
Works as a team to achieve productivity goals.
EDUCATION AND/OR EXPERIENCE
High School graduate or equivalent
Three years of experience coding professional or hospital services in an outpatient or clinic setting preferred
Knowledge of denial management preferred
CERTIFICATION/LICENSURE
Certified in professional or hospital coding (CPC, CPC-H) or other equivalent coding certification required
Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.
Mercyhealth offers competitive pay and a comprehensive benefits package including:
Medical, Dental, Vision
Life & Disability Insurance
FSA/HSA Options
Generous, accruing paid time off
Paid Parental and caregiver leave
Career advancement and educational opportunities
Tuition and certification reimbursement
Certification Reimbursement
Well-being Programs
Employee Discounts
On-Demand Pay
Financial Education
Annual recognition/awards events
Partner appreciation days
Family entertainment/attractions discount
Community service/improvement opportunities
Click here for more details regarding Mercyhealth Careers Benefit Information.
At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.
Mercyhealth has been nationally recognized for our commitment to our people and culture, including:
#1 in the nation on AARP's Best Employers for Workers Over 50
One of Working Mother magazine's 100 Best Companies for Working Mothers
A Top 50 Company and Top 10 Nonprofit for Executive Women
