Reference Title
HR Use Only: Professional Fee Coder II
Hospital: Main Campus Non-Exempt
Facility: CC Business Operations Ctr
Department: RCM Observations
Job Code: U99931
Pay Grade: 10
Schedule: Full Time
Shift: Days
Hours: 8am-4:30pm
Job Details:

Monitors, reviews and applies correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research and compliance. Identifies and applies diagnosis codes, cpt codes and modifiers as appropriately supported by the medical record in accordance with federal regulations. Ensures that billing discrepancies are held and corrected.Compares and reconciles daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges, manual data entry. Maintain records to be used for reconciliation and charge follow up. Investigates and resolves charge errors. Meet coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care. May be responsible for working held claims and claim edits in the CCF claims processing system. Maintain proficiency in related CCF billing systems. Utilize ICD#9, ICD#10 and CPT-4 coding systems and materials. Maintain productivity standards. Maintains current knowledge and skills through reading and utilizing coding resources. Attends and participates in coding education systems. Other duties as assigned.

EDUCATION: High school diploma or equivalent. Specific training related to CPC procedural coding and ICD9, ICD10 diagnostic coding through continuing education programs/seminars and/or community college. Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

LICENSURE/CERTIFICATION/REGISTRATION: CPC,CCS-P, RHIT, RHIA, or CCA (AHIMA)

COMPLEXITY OF WORK: Requires critical thinking and analytical skills, decisive judgment and work with minimal supervision. Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

REQUIRED EXPERIENCE: Candidate must be credentialed (CPC,CCS-P, RHIT or CCA). Existing CCF employees credentialed with CMC may be required to obtain CPC (or CCS-P, RHIT, or CCA) within 12 months. Minimum of two years of coding experience in a health care environment and or medical office setting required. Candidate must currently be employed as a Pro Coder I at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of Pro Coder I for six months to apply for a PRO coder II position.

PHYSICAL REQUIREMENTS: Typical physicial demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard. Manual dexterity required to locate and lift medical charts. Ability to work under stress and to meet imposed deadlines.

PERSONAL PROTECTIVE EQUIPMENT: Follows Standard Precautions using personal protective equipment as required for procedures.

Category: Finance/Information Systems