Pro Fee Coding Specialist

Saint Francis Hospital, Inc.; New Haven (CT); On-site; USD 55,000 - 75,000; Full time

Job summary

Saint Francis Hospital, Inc. in Tulsa, Oklahoma is seeking a Pro Fee Coding Specialist to review documentation and assign or correct diagnosis and procedure codes using AHIMA and AAPC resources. You will apply current coding rules and collaborate with care teams to ensure compliant claims.

The role requires extensive knowledge of coding standards, strong communication, and the ability to work independently in a busy ambulatory coding setting. This position is based on site in Tulsa.

Qualifications

• Review documentation and add or correct codes using coding resources.
• Understand medical records to support coding decisions and accuracy.
• Proficient with encoder tools and current coding guidelines.
• Communicate clearly in written and verbal form with stakeholders.
• Work independently and in a fast-paced environment with multiple priorities.

Responsibilities

• Code as assigned from medical record documentation.
• Apply current coding and billing rules to ensure accurate claims.
• Monitor denials and resolve coding-related issues.
• Review charges for corrections and rebilling as needed.
• Develop reports on claim denials and corrective measures.
• Advise providers on documentation and billing policies.
• Educate staff on coding changes and regulations.
• Collaborate with providers, office staff, and compliance units.

Skills

Medical coding knowledge

Communication skills

Attention to detail

Independent work

Team collaboration

Basic encoder skills

Education

GED/High School diploma

CCS (AHIMA)

CPC (AAPC)

BCHH-C (WellSky)

RHIA (AHIMA)

RHIT (AHIMA)

HCCS (CCB)

Tools

Microsoft 365

Medical coding software

Job description

Job Summary

The Pro Fee Coding Specialist reviews documentation and reviews, adds or corrects diagnosis and procedure codes that have been submitted by the provider. This role utilizes coding knowledge learned through valid coding resources in decision making.

Minimum Education

GED or High School diploma.

Licensure, Registration and/or Certification

• (CCS) Certified Coding Specialist - American Health Information Management Association (AHIMA)
• (CPC) Certified Professional Coder - American Association of Professional Coders (AAPC)
• (BCHH-C) Board Certified Home Health Coding Credentialing – WellSky
• (RHIA) Registered Health Information Administrator - American Health Information Management Association (AHIMA)
• (RHIT) Registered Health Information Technician - American Health Information Management Association (AHIMA)
• Hierarchical Conditions Categories (HCCS) from The Compliance Certification Board (CCB)

Work Experience

None. Experience and/or training in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded, preferred. 2 years related experience, preferred.

Knowledge, Skills, and Abilities

• Sound knowledge and understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding.
• Basic encoder skills.
• Knowledge of Microsoft 365 and other applicable software.
• Excellent communication skills, both written and verbal that present clear and concise information.
• Effective interpersonal, organizational, and multitasking skills.
• Ability to determine whether a record is complete enough to code or should be held for more documentation.
• Sound ability to be cooperative, dependable and responsive to the changing nature of the coding workflow.
• Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines.

Essential Functions and Responsibilities

• Codes as assigned from review of medical record documentation.
• Applies knowledge of current coding and billing requirements to ensure claims are submitted correctly.
• Monitors coding and billing performance and resolves denials related to coding errors.
• Performs review for charge corrections and rebilling as required for resolution of coding denials.
• Develops preventative measures in response to patterns identified through analysis of claims denial data; prepares periodic reports for clinical staff, identifying corrective measures to resolve denial problems.
• Advise and instruct providers regarding documentation and billing policies, procedures and regulations; interacts with providers regarding conflicting, ambiguous or non-specific documentation, obtaining clarification of the same.
• Educates providers and office staff regarding documentation coding and billing changes and regulations to assure compliance with local, state and national policies.
• Works collaboratively with providers, office staff, billing personnel, quality department and compliance, and coding resources to ensure accurate coding.
• Stays updated on coding rules, attends seminars and reviews and coding periodicals.

Decision Making

Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field.

Working Relationships

Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions

None.

Supplemental Information

This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Location

Health Information Ambulatory Coding - Yale Campus Location: Tulsa, Oklahoma 74136 EOE Protected Veterans/Disability.

About Saint Francis

Saint Francis is a Catholic, not-for-profit Health system based in Tulsa, Oklahoma. We are the largest private employer in Eastern Oklahoma with over 12,000 employees, including 1,000 physicians. The health system is anchored by the 1,112-bed Saint Francis Hospital, the largest hospital in Oklahoma and the 11th largest in the nation. Our system also includes hospitals in south Tulsa, Muskogee and Vinita, as well as 110 Warren Clinic locations from Monkey Island to McAlester, northeastern Oklahoma's only children's hospital, a level IV neonatal intensive care unit, a 168-bed heart hospital, and Tulsa's leading trauma and emergency center.