Professional Surgical Coder II (Onsite, Hybrid, Remote)

Professional Surgical Coder

At NorthBay, the Professional Surgical Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner for professional surgery charges in the outpatient and inpatient settings. The coder is dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines.

Primary Job Responsibilities:

1. The coder independently performs coding of patient's record to provide accurate physician, pro-fee and surgical billing and reimbursement while ensuring compliance. Codes all diagnoses and procedures according to the current classification system for the category of patient encounter.
2. Responsibilities include collecting visit information, analyzing documentation and identifying discrepancies and querying providers as necessary ensuring the accuracy and integrity of all reviewed data.
3. Utilizes the electronic health record/abstracting system/encoding/computer-assisted coding systems to carry out job functions.
4. Ensure codes are accurate and sequenced correctly in accordance with coding guidelines and government and insurance regulations. Understands edit rules including those pertaining to assistant and co-surgeons.
5. Abstracts designated demographic data into the medical record abstracting system to meet both internal and external regulatory requirements for reporting.
6. Maintains department coding productivity and quality standards.
7. Searches for information in cases where the coding is complex or unusual. Forwards unresolved coding questions to manager for review and comment
8. Keeps knowledge updated on coding requirements and compliance guidelines when required according to assigned specialty and departmental needs.
9. Serves as a resource for coding/data issues for the organization.
10. Provides timely feedback to the Manager, Professional Fee Coding, to identify operational issues. Escalates repeated and continuing problems to the Manager.
11. Works with Business Office staff to resolve any billing/coding issues. Corrects all pending diagnosis or suspend report(s) as needed.
12. Responds to audit reviews and addresses results in a timely manner.
13. Keeps Manager and/or appropriate departments aware of completed work, backlogs, physician trainings and other assigned duties by utilizing tools provided for tracking.
14. Maintains certification as a requirement of position. Enhances professional growth and development through educational programs, seminars, etc.
15. Maintains and complies with HIPAA policies and procedure for confidentiality of all patient records.
16. Complies with North Bay's Policies & Procedures, Safety Standards, TJC standards and other applicable regulatory statutes.
17. Demonstrates the True North Values of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
18. Reports into office as required and understands that if regulatory accuracy standards are not met, return to in-office work environment may be required.
19. Performs other duties as assigned.

Qualifications:

1. Education: High School Graduate or equivalent preferred. College coursework a plus
2. Licensure: Certified Professional Coder (CPC), Certified Coding Specialist (CCS),or Certified Coding Specialist Physician (CCS-P)
3. Experience:

• Five or more years of experience in professional fee coding required including surgical coding in both inpatient and outpatient settings.
• Specialty Requirement: While experience across all specialties is ideal, candidates must have experience in a minimum of two of the following: Podiatry, Otolaryngology, OB-GYN, Orthopedics, Neurosurgery, Urology, Vascular, Cardiology, Interventional Radiology, Gastroenterology/GI Endoscopies, or Cardiothoracic Surgery.
• Some leadership experience preferred, but not required.
• EMR Medical records experience is required. Experience with an encoder system preferred.
• Comprehensive knowledge and application of profee surgical guidelines including appropriate coding of assistants and co-surgeons
• Demonstrated knowledge of anatomy and physiology, medical terminology, disease process, reimbursement methodologies (DRGs, HCCs, APCs), and the conventions, rules and guidelines for current coding classification (ICD10-CM, CPT and HCPCS).
• Demonstrated understanding of the clinical content of a health record.
• Knowledge of and experience with PC's, Cerner, and/or computer systems and programs highly desired.
• Microsoft Office: Email, Word, Excel.
• Has a comprehensive understanding of insurance requirements and compliance guidelines for Medicare, PHP, WHA and Medi-Cal, Worker's Compensation, Commercial Insurances.

1. Skills:

• Technically savvy (ability to learn software and troubleshoot equipment as needed)
• Ability and self-discipline to be able to work remotely. Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements. The ability to work independently as well as in a team environment.

Hours of Work :

• Full Time Days Monday through Friday as assigned.
• Timing may also be at discretion of leadership based on business need.

Other Requirements:

• Must have a private, distraction-free area in your home for work (HIPAA reasons)
• Web-cam training will be used frequently for team engagement.
• Internet Requirements: Must have high speed internet. Please test your internet prior to applying to make sure you are over 125 mbps download speed or be willing to upgrade upon an offer.

1. Interpersonal Skills: Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.

2 Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

3 Physical Effort:

Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit for long periods of time.
• Ability to lift, push or pull 5 pounds
• Occasional bending, stooping, crouching, reaching
• Ability to concentrate and maintain accuracy despite frequent interruptions.
• Keyboarding skills

4. Hours of Work : Full Time Days Monday through Friday as assigned. Timing may also be at discretion of leadership based on business need.

Other Requirements:

Must have a private, distraction-free area in your home for work (HIPAA reasons)

Web-cam training will be used frequently for team engagement.

Internet Requirements: Must have high speed internet. Please test your internet prior to applying to make sure you are over 125 mbps download speed or be willing to upgrade upon an offer.

Remote Work Eligibility: This position is open to candidates located within the continental United States . Due to state-specific employment requirements and workers' compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands.

Compensation : $42.24 to $51.34 based on years of experience doing the duties of the role.