Pro Fee Coding Spec - Professional Services Coding - Full-Time - Days
Pro Fee Coding Spec - Professional Services Coding - Full-Time - Days
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Kettering Health is a notforprofit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with highquality care for every stage of life. Our serviceoriented mission is in action every day whether its by providing care in our facilities training the next generation of health care professionals or serving others through international outreach.
Responsibilities & Requirements
This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation.
KPN Pro Fee Coding Specialist
Serves as the subject matter expert ensuring coding compliance knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.
- Demonstrates knowledge of CPT HCPCS ICD10 and CMS NCCI edits
- Accurately assess documentation in EPIC EMR to assign appropriate CPT HCPCS and ICD10
- Reviews and researches pending and denied claims pertaining to professional fee coding CMS NCCI edits and/or medical necessity requirements CMS LDC/NCD and/or payer policy
- Demonstrate initiative for maintaining current knowledge of CPT ICD10 and CMS NCCI edits
- Corresponds with providers on pending claims to facilitate resolution
- Responsible for participating in departmental goals KHN mission and implemented KHN/KPN policies
- Communicate appropriately with providers leaders and staff
- Researches and resolves concerns timely
Educational Requirements:
High School Diploma or equivalent
RHIT RHIA CCS CCSP CPC or eligible specialty certification
Prior experience in professional fee coding/billing
Knowledge and Skill:
CPT HCPCS Modifiers ICD10 and CMS NCCI Edits
Medical Terminology and Anatomy & Physiology
Computer and EPIC Applications
Excellent verbal and written communication skills
Abilities:
- Charge Review WQ Edits
- Reviews researches and responds to Charge Review WQ edits pertaining to coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Corresponds and communicates appropriately with providers on coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Demonstrates knowledge of CPT HCPCS ICD10 and CMS NCCI edits
- Claim Edit WQ Edits
- Reviews researches and responds to Claim Edit WQ edits pertaining to coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Corresponds and communicates appropriately with providers on coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Demonstrates knowledge of CPT HCPCS ICD10 and CMS NCCI edits
- Follow Up WQ Denials
- Reviews researches and responds to Follow Up WQ edits pertaining to coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Corresponds and communicates appropriately with providers on coding CMS NCCI edits and/or medical necessity requirements to facilitate resolution.
- Demonstrates knowledge of CPT HCPCS ICD10 and CMS NCCI edits
- Departmental Responsibilities
- Responsible for participating in departmental goals KHN mission and implemented KHN/KPN policies
- Demonstrate initiative for maintaining current knowledge of CPT ICD10 and CMS NCCI edits
- Follow procedures pertaining to position
- Researches and resolves concerns timely
Required Experience:
Unclear Seniority
Employment Type
Full-Time
