• Job Description

  Req#: 42870
  Overview
  
  

  Performs coding reviews and claim audits in order to resolve coding edits and denial issues, (outpatient, inpatient, and clinical episodes of care), providing education to all partners. Performs both professional and facility coding functions to ensure compliancy. Performs other duties as assigned. May be asked to work weekends and reasonable amounts of overtime when necessary.

  
  Responsibilities
  
  

  Essential Duties and Responsibilities

  • Reviews, analyzes, and interprets documentation and identifies discrepancies between the code selection and the documentation; corrects them, and presents findings and education to the appropriate partner.
  • Resolves pre-bill claim edits from all areas and as identified by claims scrubbing software.
  • Maintains a close working relationship with departmental staff, frequently querying them and providing education when coding discrepancies arise.
  • Researches and provides education to all partners regarding CMS policies related to outpatient coding, inpatient coding, and professional fee coding, and presents findings to them.
  • Solves complex billing and claim denial issues related to coding by researching policies and guidelines.
  • Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA), the Center for Medicare & Medicaid Services (CMS) and contracted payers.
  • Has a thorough understanding of the differences between professional coding in a clinic setting as compared to professional coding in a hospital setting (outpatient and inpatient), and demonstrates a high skill level in the practical application of that knowledge.
  • Maintains an in-depth knowledge of Epic billing, ambulatory, and hospital modules.
  • Responds to customer concerns through coding reviews requested by other departments.
  • Assists with all coding functions at or above the level of a Medical Coding 1 job description.
  • Works as a team to achieve productivity goals.

  
  Education and Experience

  High School graduate or equivalent
  Three years of experience coding professional or hospital services in an outpatient or clinic setting preferred
  Knowledge of denial management preferred

  
  Certification and Licensure

  Certified in professional or hospital coding (CPC, CPC-H) or other equivalent coding certification required

  
  Benefits
  
  

  Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to:

  · Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

  · Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

  · Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

  · Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

  · Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

  · Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.

  
  

  Essential Duties and Responsibilities

  • Reviews, analyzes, and interprets documentation and identifies discrepancies between the code selection and the documentation; corrects them, and presents findings and education to the appropriate partner.
  • Resolves pre-bill claim edits from all areas and as identified by claims scrubbing software.
  • Maintains a close working relationship with departmental staff, frequently querying them and providing education when coding discrepancies arise.
  • Researches and provides education to all partners regarding CMS policies related to outpatient coding, inpatient coding, and professional fee coding, and presents findings to them.
  • Solves complex billing and claim denial issues related to coding by researching policies and guidelines.
  • Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA), the Center for Medicare & Medicaid Services (CMS) and contracted payers.
  • Has a thorough understanding of the differences between professional coding in a clinic setting as compared to professional coding in a hospital setting (outpatient and inpatient), and demonstrates a high skill level in the practical application of that knowledge.
  • Maintains an in-depth knowledge of Epic billing, ambulatory, and hospital modules.
  • Responds to customer concerns through coding reviews requested by other departments.
  • Assists with all coding functions at or above the level of a Medical Coding 1 job description.
  • Works as a team to achieve productivity goals.

  
  Education and Experience

  High School graduate or equivalent
  Three years of experience coding professional or hospital services in an outpatient or clinic setting preferred
  Knowledge of denial management preferred

  
  Certification and Licensure

  Certified in professional or hospital coding (CPC, CPC-H) or other equivalent coding certification required

• About the company

  Mercyhealth is a non-profit health care provider and hospital system based in Janesville, Wisconsin.

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