Job Description

Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD-10, CPT, and HCPCS, modifier and/or other codes according to coding guidelines. Communicates effectively with providers and/or all appropriate staff regarding missing information such as CPT, ICD-10, and documentation issues, to ensure proper coding and reimbursement. Works with the Associate Director to review denial and reimbursement reports for accuracy, as well as conducting audits to ensure documentation, code capture, and billing are accurate and precise. Performs pre and post visit chart audits to ensure proper code assignment.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS: 

PERFORMS PRE-VISIT CHART AUDITS, AND POST ENCOUNTER REVIEW TO ENSURE CODING ACCURACY:

• Is able to review medical records to ensure codes reported are support by the documentation
• Reviews medical records for correct ICD-10, CPT, documentation and modifiers.
• Is able to review reports with Associate Director to identify reimbursement changes/discrepancies.
• Can assist with training of providers on proper coding and documentation

MAINTAINS A CURRENT AND STRONG UNDERSTANDING OF CODING RULES AND CMS GUIDELINES IN THE OUTPATIENT SETTINGS:

• Is able to interpret and summarize ICD-10-CM and CPT coding changes, and updates
• Incorporates changes to guidelines and regulations into audit practice
• Researches and resolves coding and documentation regulatory issues
• Is able to articulate coding and documentation guidelines changes to appropriate parties including, but not limited to providers.

REPORTING:

• Review and work audit lists provided by Associate Director regarding coding/billing changes, as well as denial reports.
• Identifies and evaluates coding issues, summarizes findings for leadership, makes recommendations for course of action

Qualifications

EDUCATION:

• CPC, CCS, RHIA, or RHIT required

EXPERIENCE:

• MINIMUM 2-5 YEARS OF OUTPATIENT CODING, BILLING, PRIMARY CARE ADULT MEDICINE AND PEDIATRIC EXPERIENCE
• Excellent organizational and interpersonal skills are essential as well as the ability to work on multiple tasks, to work under pressure, meet deadlines and provide excellent follow up. 
• Communication skills are essential.  The ability to give oral presentations to staff as well as written skills to prepare reports for management.
• The ability to work effectively as a member of a team is essential.
• The ability to provide education and feedback to physicians on a regular basis in order to ensure CPT, ICD-10-CM, and Risk Adjustment guidelines are being met.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Working in an office and/or remote setting
• Being available for in person and/or virtual meetings when needed.
• Frequent contact with physicians and their office staff, insurance representative, medical directors, department heads and administrative managers.

Additional Information

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.