Friday, October 18, 2013

Professional Fee Coding Specialist

Job Description:

The Professional Fee Coding Specialist reviews clinical documentation and diagnostic results to extract data and apply appropriate ICD-9 CM and CPT - 4 codes for billing, internal and external reporting, research and regulatory compliance. This individual accurately codes outpatient (i.e., diagnostic, therapeutic, ambulatory surgery and observation service encounters), conditions and procedures as documented in ICD-9-CM Official Guidelines for Coding and Reporting. Provides information and direction relevant to coding to physicians. A participant in ICD -10 implementation, document review and staff training; reports to the Director of Ambulatory Operations and the Senior Director, Hospital-Based Practices.

Duties and Responsibilities:

1. 1.Upon review of patient medical records, assigns ICD-9/ ICD-10 and CPT (Current Procedural Terminology) codes for diagnoses, treatments, surgical and non-surgical procedures for professional ambulatory services rendered. Assesses support documentation.

2. 2.Conducts chart audits in preparation for ICD-10. Based upon audit results, provides feedback to physicians and staff regarding template development/revision to enhance the accuracy of patient record documentation to satisfy ICD-10 requirements. Works with physicians on an ongoing basis.

3. 3.Provides written reports to supervisor or manager with audit results. Documents any coding deficiencies noted.

4. 4.Reviews, modifies and recommends changes to policies, procedures, EPIC templates and encounter forms to improve professional fee coding and data management.

5. 5.Serves on committees and work groups as appropriate, including the ICD-10 Steering Committee.

6. 6.Serves as an ambulatory subject matter expert for ICD-10-PMS coding.

7. 7.Uses 3M encoder logic and grouper software to assign diagnosis and procedure codes. Utilizes the clinical analyzer to assist in appropriate reimbursement under AAPC system guidelines.

8. 8.Maintains a working knowledge of CPT-4 and ICD-9-CM coding principles, government regulations, protocols and third -party requirements pertaining to billing and documentation.

9. 9.Assists in the development and implementation of quality assurance programs to monitor staff competency and establish new methodologies to enhance the performance of various departments assigned.

10. Other duties as assigned


Job Qualifications:


Associates degree (higher level of education is preferred), or equivalent combination of education and relevant coding work experience.


3 years minimum (5 years preferred) of outpatient coding experience.

Proficiency in the use of computer-assisted coding software; 3M knowledge is desirable.

Ability to create and utilize the coding audit tools required to include the facilitation of coding deficiency resolution with physicians, managers and staff.

CPC certification preferred not required.

Mount Sinai Medical Center is an equal opportunity/affirmative action employer. We recognize the power and importance of a diverse employee population and strongly encourage applicants with various experiences and backgrounds.

Mount Sinai Medical Center--An EEO/AA-D/V Employer.

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