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Brown University Health · 2 months ago

Professional Coder

Providence, RI

Full-time

Onsite

Entry Level

$21.61/hr - $35.66/hr

1+ years exp

Brown University Health is seeking a Coding Specialist who reports to the Manager of Physician Coding. The role involves ensuring appropriate diagnostic and procedural codes are submitted for professional charges, resulting in accurate claims processing, data retrieval, and analysis.

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Responsibilities

Assesses the adequacy of the documentation for the provider visit or procedure which supports the diagnosis

Reviews procedure codes selected by the provider for hospital services and complex office services, all diagnoses for medical necessity and adequate specificity

Queries providers when documentation in the patient record is inadequate, unclear, does not support the code assigned, or indicates that additional services were performed that were not coded

With provider consent, corrects and revises codes, as necessary, to ensure compliance with federal law and payer guidelines and requirements and to ensure optimal reimbursement

Refers coding, billing, and system questions to the Manager after exhausting own efforts to answer them by referencing appropriate coding publications and other resources

Performs audits of provider coding and documentation, as required, and educates providers regarding improvement in both

Remains current with coding guidelines and documentation requirements

Maintains coding certification by earning required continuing education units

Performs other related duties, as assigned

Qualification

CPT-4 codingICD-9/10 codingHCPCS codingMedical billing experienceCoding certificationComputer skillsEpic experienceWriting skills

Required

High school diploma or equivalent

Successful completion of formal education in medical coding

Certification from the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other association required

One year medical billing experience in a hospital, medical office, or billing company, or the equivalent

Ability to analyze patient record and to recognize and analyze clinical documentation pertinent for coding

Writing skills sufficient to prepare physician queries

Computer skills to research internet websites to clarify diseases or procedures and to access payer policies

Ability to use computer applications, including Excel, Word, Adobe Reader, Microsoft Outlook and third party payer websites