Please Email Your Resume Directly to Brandon Johnson at Dean Clinic

Please email your resume directly to Brandon Johnson at Dean Clinic.

Brandon Johnson | Talent Specialist

Dean Clinic - Corporate Offices

Human Resources

1802 W Beltline Hwy

Madison, WI 53713

Phone: 608.250.1484 | TL 540 | Fax 608.250.1441

| www.deancare.com

Partners who care

Position Summary:

The Coder 1 – Outpatient, under the supervision of the Coding Supervisor, is responsible for abstracting clinical information and assigning CPT, ICD-CM and HCPCS (supplies and pharmaceuticals) codes from medical records and documents to support physician professional fees, including, but not limited to, outpatient evaluation and management (E/M) services (e.g. outpatient visits, consultations, preventive care, etc.) and office procedures in accordance with American Hospital Association Official Coding Guidelines (ICD), American Medical Association’s (AMA) CPT definitions and instructions, and third party payor guidelines, including the Centers for Medicare and Medicaid (CMS) specific policies. They are also responsible for monitoring and following-up on pending documentation, updating encounter forms to incorporate new and revised codes, serving as a liaison between physicians, coworkers and other staff by answering questions as they relate to documentation and coding.

Qualifications:

Required:

1.  High school diploma or equivalent with certification as an RHIT, RHIA, CPC-A, CPC, CCS-P, CCS, CCA, or CPMA OR graduation from an accredited Medical Coding Specialist (MCS) program with agreement to become certified within 12 months of employment.

2.  Knowledge of medical terminology, anatomy, physiology and disease process.

3.  Knowledge of and how to interpret the contents of a medical record.

4.  Knowledge of CPT and ICD-CM coding.

5.  Knowledge of reimbursement practices for physician services.

6.  Ability to work independently.

7.  Establish work priorities and adjust them as the circumstances dictate.

8.  Ability to work well in a busy area with constant interruptions.

9.  Maintain patient and Medical Center confidentiality.

10.  Computer experience.

11.  Good oral and written communication skills.

12.  Energetic and flexible in working as part of the team.

Preferred:

1.  Experience with Epic or an EHR.

2.  Experience with Microsoft Office products.

Responsibilities:

1)  Interpret, abstract and complete:

a)  Medical center patient records for evaluation and management codes, office procedures, ancillary services and nursing home services from documentation to include: assignment of CPT, ICD-CM and HCPCS codes and modifiers, and ensure CMS and third party carrier policies/regulations are followed.

b)  Research of missing charges for any clinic site. Research will involve chart review and interaction with the physician to identify missing information.

2)  Analyze:

a)  Audit requests specific to coding and billing issues by abstracting the patient chart information and following appropriate AMA, CMS, and contract guidelines. Compile and summarize the results. Forward the results to the Coding Supervisor.

b)  Insurance edits, charge review workqueue sessions and Inbasket issues, using coding knowledge to review and correct issues such as bundling edits, multiple procedure rules, incompatible diagnosis codes, etc. to determine appropriateness of edit, charge session or Inbasket and the action to be taken. Such action may include changing codes, resubmitting the claim, or writing an appeal letter to the insurance company to rebut the edit.

c)  Determine the appropriateness of the coding, contact the physician when necessary for clarification or educational purposes, responding to the patient if necessary via written communication with outcome, working with the DHS insurance department or external insurance company to resolve the issue.

d)  Medical records for individual and department audits or reviews. The audits and reviews may be done for the Office of Medical Affairs, as part of a focused audit, at the request of the provider, administrator or manager, and as part of the shadowing program offered by the Coding Department.

e)  Medical records to determine the appropriateness of coding and potential patterns of abuse. Includes working with appropriate DHS or external parties to resolve the issue(s).

f)  Charge Review Workqueue, Follow-Up Workqueue, Charge Router and InBasket issues. Resolve issue by following department, payor and industry standard coding guidelines.

g)  Denial reports through abstraction and research to determine and resolve appropriateness of the denials. Suggest new guidelines, workqueue rules and education as part of the resolution.

h)  Physician compensation reports for proper coding when requested.

3)  Remain current:

a)  By attending conferences, audio conferences and workshops such as the AAPC audio conferences and local chapter meetings as needed to stay current with coding and documentation guideline changes.

b)  With CPT, ICD-CM and HCPCS coding changes, as well as unique documentation or coding requirements by payor types (i.e. CMS) and contractual arrangements.

c)  With use of Coding Library materials, DHS Coding and/or Compliance Guidelines and on line sources related to coding requirements.

d)  With the current practices and procedures of the business office departments (i.e., Patient Accounts, Insurance, Workers Compensation, Patient Relations, etc.) to be able to understand the impact on the patient’s charges, to better identify the action to be taken by these departments, and to be able to communicate to the appropriate parties, insuring the correct outcome.

e)  By maintaining credentialing certification.

4)  Support:

a)  Providers through daily interactions to problem solve and trouble shoot coding issues with the authority to advise and recommend coding solutions and change codes according to documentation and coding guidelines.

b)  Providers through coding orientation sessions.

c)  Coworkers to problem solve and trouble shoot coding issues through daily interactions and responses to questions.

d)  Establish and maintain working relationships with providers and peers as required to perform the responsibilities of this position. Examples of such actions may be meeting with physicians and workgroup members to assist with valuing new procedures, as well as obtaining clarification on potential bundling issues and denials.

e)  Business office areas such as Credit, Patient Accounts and Insurance, in addition to the physician and patient care staff, by acting as a coding resource to answer questions and educate on coding matters. Respond to requests in a timely, efficient and friendly manner.

f)  Patients and coworkers through timely response to Inbaskets and coding information line questions.

g)  And assist other departments with review of physician services and documentation, coding education and other needed assistance.

h)  Timely and accurate coding of all provider services by keeping encounter forms current as new codes become available for every department and provider type.

i)  Efficiency of DHS by identifying areas of waste or duplication and providing suggested resolution to the matter.

5)  Perform other duties as assigned.

Position descriptions are not intended to be, and should not be, constructed to be a complete list of all the duties and responsibilities performed by incumbents. Duties, responsibilities and expectations may be added, deleted or modified at any time at the discretion of the supervisor.

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