Professional Coding Specialist III - Edits

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Reviews all surgical documentation to assign accurate ICD-10, CPT, HCPCS codes, and modifiers for complex procedures performed throughout WVU Medicine. Complies with national coding guidelines to ensure that all procedures are coded accurately and consistently. Applies coding conventions and rules established by the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) when assigning procedural, diagnostic, and HCPCS codes to ensure that they are in accordance with CCI edits, MUE edits, LCD, and NCD’s. Contacts & Collaborates with appropriate personnel for documentation insufficiencies and to expedite resolution of accounts.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School Diploma or Equivalent.

2. Current HIM/Coding Certification through ONE of the following :

American Health Information Management Association (AHIMA)

A merican Academy of Professional Coders (AAPC)

3. Must obtain Specialty Medical Coding Certification through the A merican Academy of Professional Coders (AAPC) within one (1) year of hire.

EXPERIENCE:

1. Three (3) years of medical coding experience to include o ne (1) year of advanced surgical coding experience .

PREFERRED QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associates degree in Health Information Management.

EXPERIENCE:

1. Four (4) years of coding experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Accurately codes and/or audits complex surgical procedures as part of daily workload (85%-95% of workload) including but not limited to: Bariatric surgery, Cardiothoracic surgery, Gynecologic surgery, Oncology surgery, Orthopaedics surgery, Thoracic surgery, Transplant surgery, Trauma and burn surgery, and Open Vascular surgery.

2. Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified.

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

4. Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.

5. Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.

6. 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.

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

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

9. Analyzes and resolves issues of missing charges and problem accounts by researching information regarding department reimbursement.

10. Interacts with physician and non-physician providers to maximize correct coding initiatives.

11. Maintains a level of expertise and ever expanding knowledge in coding and sequencing guidelines to ensure that all healthcare information is accurately assigned and appropriate.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment.

4. Must be Able to lift, push or pull 10-20 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.

3. May require travel.

SKILLS AND ABILITIES:

1. Must be able to concentrate and maintain accuracy during constant interruptions.

2. Must possess independent decision-making ability.

3. Must possess the ability to prioritize job duties.

4. Must be able to handle high stress situations.

5. Must be able to adapt to changes in the workplace.

6. Must be able to organize and complete assigned tasks.

7. Must possess excellent written and verbal communication skills.

8. Must meet quality and productivity standards.

9. Must possess the knowledge of anatomy, physiology and medical terminology.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

539 SYSTEM HIM Provider Based Coding Analysis

Address:

1 Medical Center Drive

Morgantown

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.