The Professional Fee Coder is part of a team which has full responsibility for the efficient and accurate flow of coded professional and technical charges. Coder applies the appropriate diagnoses from limited diagnostic and procedural codes (radiology) and applicable modifiers to individual patient health information for data retrieval, analysis and claims processing. Works closely with departments to optimize reimbursement, ensure charge capture, reduce late charges and provide feedback to providers. Provides physicians routine feedback on documentation and compliance standards. Resolves pre-bill edits and appropriate follow-up. Exercises judgment within defined procedures and practices to determine appropriate action. Receives general instructions on routine work, detailed instructions on new assignments.
The job duties listed are typical examples of work performed by positions in this job classification and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility. Employees may also perform other duties as assigned.
Adheres to official coding guidelines.
Applies CPT-4, ICD-10-CM, HCPCS and modifiers following coding guidelines.
Code all documented professional services and submit for billing.
Ensure coded services, provider charges and medical record documentation meet appropriate guidelines or standards.
Ensures all services are accounted for and billed.
Keeps abreast of coding guidelines and reimbursement reporting requirements.
Provides feedback to physicians related to revenue opportunities.
Queries physicians when code assignments are not straightforward or documentation in the record in inadequate, ambiguous, or unclear for coding purposes.
Utilize appropriate methods to ensure all documented professional services are submitted timely.
Utilizes correct coding practices to file clean claims aiding in improved cash flow.
Reconcile charges by ensuring all charges exported from Aria and Epic to 1:1 ratio
Ensures all error work queues are addressed timely
Initiate A3 to decrease controllable write-offs and charge lag
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: Associate's degree in a work-related field/discipline from an accredited college or university or an equivalent combination of education/experience.
Experience: One year of directly related work experience. Radiation therapy experience is preferred.
License/Certifications: Certified Professional Coder Certification (CPC) or Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) or Certified Coding Specialist-Physician Based (CCS-P) or Certified Coding Specialist (CCS); or completion of certifications within 6 months of hire.
Knowledge, Skills and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to conduct analysis and formulate conclusions
Ability to plan, organize, prioritize, work independently and meet deadlines
Ability to speak and write effectively at a level appropriate for the job
Ability to utilize the ICD-10-CM & CPT-4 coding conventions to code medical record entries.
Knowledge of specialized treatments such as but not limited to SRS, SBRT, HDR, and Cyberknife.
Ability to abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
Knowledge of computer systems and software used in functional area (Aria and Epic)
Knowledge of medical terminology, anatomy, disease processes and operative procedures; demonstrated ability to incorporate these in making sounding coding
Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
Proven record of accuracy, productivity, dependability, and problem-solving skills
Resourceful, tactful, firm, cooperative in team setting
Ability to work independently
Excellent communications skills verbal and written
Good phone etiquette
Set priorities effectively in an environment of multiple demands