This position is responsible for coding all services including major and minor surgical cases and evaluation and management (E/M) levels performed in both the office and hospital setting for MidMichigan Physicians Group, Family Practice Center and the MidMichigan Urgent Care locations. This position monitors compliance with third party payers guidelines while ensuring the maximum allowed reimbursement is attained. This position requires broad knowledge of current payer rules for all insurance companies we participate with, in addition to analytical skills to ensure all procedures are coded correctly for a timely and accurate reimbursement from all payers. This position must be able to work independently and make decisions based on their broad knowledge of current procedure terminology (CPT) and International Classification of Diseases (ICD) coding rules and regulations.
Essential Duties & Responsibilities
- (25%)* Codes all E/M visits, performed in both the office and hospital setting within 48 hours of receipt.
- (25%)* Uses the Epic coding edits, CPT Assistant, and Centers for Medicare and Medicaid Services (CMS) coding guidelines to make necessary corrections to ICD, CPT, Healthcare Common Procedure Coding Systems (HCPCS), codes, modifiers and place of service to ensure clean claims.
- (20%)* Codes all major and minor surgical cases, including obstetrics, performed in both the office and hospital setting, within 48 hours of receipt.
- (20%)* Utilizes clinical knowledge to interact with physicians/provider on a regular basis to assist in improving documentation.
- (10%)* Demonstrates willingness to participate in continuing education to enhance coding knowledge.
OTHER DUTIES AND RESPONSIBILITIES:
- Reviews accounts related to patient or payer complaints/concerns.
- After review, responsible for timely communication to the patient, payer and physician (if needed) to address their concern.
- Meets established productivity guidelines.
- Other duties as assigned.
- MidMichigan Health is a technology-driven organization and employees need to demonstrate competency organization in Microsoft® Windows.
- Employees may be required to participate in further learning opportunities offered by MidMichigan Health.
REQUIRED EDUCATION, EXPERIENCE, TRAINING AND SKILLS:
- Essential: CPC-A, CCS-P, RHIT, or RHIA
- Essential: Effective May 1, 2019, new hires must be RHIA or RHIT eligible and successfully complete the certification exam within six (6)months of hire and maintain the certification to meet the requirements of the position. Employees hired prior to May 1, 2019, and have a Certified Professional Coder (CPC) certificate without a RHIT designation are grandfathered. They must however maintain the certification to meet the requirements of the position.
- Required: Fingerprinting
- Two (2) years physician coding and billing experience and four (4) years experience in the medical field is preferred.
- Knowledge of medical terminology and anatomy.
- Proficiency in the use of personal computers. Knowledge of medical record/patient confidentiality laws.
- Great organizational skills are required.
- Oral, written and interpersonal skills needed to communicate successfully with individuals and groups and interact with people at all levels to communicate ideas and concepts in a clear and understandable manner.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:
- Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
- Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
- Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
- Overall vision and hearing is necessary with or without assisted device(s).
- Frequently required to sit/stand/walk for long periods of time.
- May require frequent postural changes such as stooping, kneeling or crouching.
- Some exposure to blood borne pathogens and other potentially infectious material.
- Must follow MidMichigan Health bloodborne pathogen and TB testing as required.
- Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
- Overall dexterity is required including handling, reaching, grasping, fingering and feeling.
- May require repetition of these movements on a regular to frequent basis.
- Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.