Summary

Job Description

POSITION SUMMARY:

The Coding Specialist is responsible for supporting Penn Medicine Lancaster General Health Physicians (LGHP) by reviewing, promoting, and evaluating professional coding and professional fee billing. This position serves as a first point of contact for coding inquiries and acts as a resource to practices for coding issues and education. The Coding Specialist helps to optimize revenue through appropriate coding while adhering to official coding guidelines for the purpose of assuring accuracy and compliance when billing insurance carriers. This position is responsible for the performance of annual chart reviews of professional fee billing specifically for LGHP and certain LGH Practices.

To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospital and outside agency requirements. This includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record. This position is an integral part of the revenue cycle as it pertains to physician coding and billing functions, as such will interact with physician and non-physician providers to maximize correct coding initiatives. Responsible for analyzing and resolving issues of missing charges and problem accounts by researching information regarding department reimbursement.

HOURS:

Full time- 40 hours weekly.

Monday- Friday hours can be discussed upon hiring

No weekends or Holidays

Remote work after training

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Perform systematic reviews of professional fee billing and coding for non-governmental carriers using an established point system ensuring that documentation supports billed services.

• Ability to educate providers from research and audit findings as needed.

• Compiles and prepares materials for meetings as necessary; ensures accuracy of information provided.

• Prepare and present coding education to new providers joining the practices to ensure understanding current evaluation and management guidelines Identify patterns in denials working with appropriate parties to correct errors and mitigate future errors.

• Researches topics with the capability to interpret complex rules and regulations.

• Keeps abreast of CPT coding changes

• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas

• Contacts physicians or any persons necessary to obtain information required to accurately code assignments.

• Works and communicates with other offices in any manner necessary to facilitate the billing process.

• Monitors on an on-going basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.

• Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

• Prepare and present coding education to new providers joining the practices to ensure understanding current evaluation and management guidelines

• Review and resolve charges in work queues based on payer edits, CCI edits, and coding-related denials

• Collaborate with customer service department to resolve coding-related patient complaints

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Monitors payer guidelines to ensure accurate coding, including local Medicare Administrative Contractor guidance, state payer rules, regulations, and trade publications.

• Assist the team with occasional special projects

• Other duties as assigned

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High school diploma or equivalent (GED)

• Certification as Certified Coding Specialist for Physicians (CCS-P) or a Certified Professional Coder (CPC). If not certified, coding certification is required within three (3) years of employment

• Two years of practical coding experience.

PREFERRED QUALIFICATIONS:

• Formal education in ICD-10-CM coding, CPT-4 coding, and medical terminology Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), COC-A (Certified Outpatient Coder-Apprentice), COC (Certified Outpatient Coder), Formerly CPC-H (Certified Professional Coder-Hospital), or CIC (Certified Inpatient Coder).

• Graduate of Health Information Technology (HIT) or equivalent program OR Medical Coding Certification Program.

• Experience with electronic health records, preferably EPIC.

• Extensive experience with coding software products.

• Experience with technical writing/report writing.

• One (1) year experience with Epic

• Three (3) to five (5) years’ experience with physician billing

• One year of medical coding experience strongly preferred.

COGNITIVE REQUIREMENTS

Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.

• The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.

New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.

• The position requires that an individual be able to learn new tasks quickly and effectively. Job requirements change frequently. The ability to understand and carry out detailed, involved instructions is mandatory.

Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.

• The position required much autonomy of thought and problem solving. The individual must be able to apply principles of logical or scientific thinking to define problems. The individual must be able to think abstractly, which is manifested in the ability to form concepts, use categories, generalize from single instances, apply procedural rules and general principles, and be aware of subtle or intrinsic aspects of a problem. The development of hypothesis and potential solutions to problems involves careful interpretation, analysis and diagnosis. The individual must be able to collect data, establish facts, and draw valid conclusions. The individual must be able to think creatively with a degree of inventiveness, experimentation and intuition. They must be able to deal with a variety of concrete and abstract variables.

APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.

Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.

Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products and web-based applications

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement :

• Sit: Frequently

• Stand: Occasionally

• Walk: Occasionally

• Bend: Rarely

• Push: Rarely

• Pull: Rarely

• Kneel/Squat: Rarely

• Reach: Rarely

• Twist: Rarely

• Balance: Rarely

• Climb: Rarely

Lifting: Degree of physical exertion is:

Light , exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

• Vision

• Hearing

• Touch/Feeling

PHYSICAL ENVIRONMENT

WORKING CONDITIONS:

Exposure to hazardous conditions/ materials is negligible.

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.

Benefits At A Glance:

PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:

• 100% Tuition Assistance at The Pennsylvania College of Health Sciences

• Paid Time Off and Paid Holidays

• Shift, Weekend and On-Call Differentials

• Health, Dental and Vision Coverage

• Short-Term and Long-Term Disability

• Retirement Savings Account with Company Matching

• Child Care Subsidies

• Onsite Gym and Fitness Classes

Disclaimer

PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.

PENN MEDICINE LANCASTER GENERAL HEALTH, a member of the University of Pennsylvania Health System (Penn Medicine), is a not-for-profit health system with a comprehensive network of care encompassing Lancaster General Hospital (LGH), Women & Babies Hospital and the Lancaster Rehabilitation Hospital (a partnership with Kindred Healthcare). We are an Accredited Trauma Center-Level I through the Pennsylvania Trauma Systems Foundation with 805 Licensed beds. Our membership in Penn Medicine brings together the strengths of a world-renowned, not-for-profit academic medical center and a nationally recognized, not-for-profit community healthcare system.

Outpatient services are provided at the Downtown Outpatient and Suburban Outpatient Pavilions, along with additional outpatient centers and Express and Urgent Care locations throughout the region. Lancaster General Health Physicians is a network of more than 300 primary-care and specialty physicians, at more than 40 offices throughout the region.