SCOPE OF POSITION
The Coding Claims Facilitator will be responsible to to provide accurate and timely coding, claims editing or correction of denials for diagnostic data. The Coding Claims Facilitator is accountable for conversion of diagnoses and treatment procedures into ICD-9, ICD- 10, and CPT coding classification systems. Coded diagnostic information is also used in strategic and long range planning. The Coding Claims Facilitator must act independently in highly diversified and complex situations. Must be able to make sound decisions objectively and follow through. Much initiative is required in obtaining diagnoses from physicians. The Coding Claims Facilitator will have responsibility in orientation and training of new employees and/or students. The Coding Claims Facilitator will be active in Corporation wide performance improvement processes and participate as a PI team member as requested. The Coding Claims Facilitator must meet 95% accuracy. Errors can hinder the Corporation in providing documentation showing the need for additional services/equipment. The Coding Claims Facilitator must consistently meet coding productivity standards. The Coding Claims Facilitator will satisfy all edits and denials for claims across the system which could include modifier edits, medical necessity edits, separate procedure edits, mutually exclusive edits, etc. The Coding Claims Facilitator will be able to satisfy the edit or denial and process the claim for billing by reviewing the edit sent by the billing system, identifying the reason for the edit, then changing the codes reported, reviewing the medical record for documentation and adding ICD-9/ 10 diagnoses codes or CPT/ HCPCS codes, adding modifiers, etc. in Compliance with all regulatory agencies. The Coding Claims Facilitator must be able to maintain cooperative working relationships with coworkers, patients and providers. It is vital that an individual in this position be capable of good communication skills. It is of the utmost importance that written communication is legible. Critical thinking skills are a must for this position. The Coding Claims Facilitator will code claims as assigned before claim is processed for billing. The Claims Facilitator must be able to work with limited supervision. It is vital that an individual in this position be capable of good communication skills. It is of the utmost importance that written communication is legible.
Coding Claims Facilitator will complete and pass all competency requirements for the position.
REPORTING RELATIONSHIP
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EDUCATION AND EXPERIENCE
Two years experience as a Coder, Coder Facilitator, or pertinent Revenue Integrity preferred. Knowledge and understanding of medical science, medical terminology, pathology, anatomy, physiology, etc.
Valid and active CPC or CPC-A certification
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