Professional Fee Coder III – Anesthesia

Responsibilities:

• Compares and reconciles daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges, manual data entry.
• Maintains records to be used for reconciliation and charge follow up.
• Investigates and resolves charge errors.
• Meets coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
• Responsible for working professional held claims in CCF claims processing system. Work accounts in the CCF claims processing system.
• Reviews, abstracts and processes services from surgical operative report.
• Reviews, communicates and processes physician attestation forms.
• Communicates with physician and other CCF departments (co-surgery) to resolve documentation discrepancies.
• Assists with Evaluation and Management (E&M) audits and other reimbursement reviews.
• Responsible for working E&M denials on the denial database.
• Reviews the Medication Administration Report (MAR) in the medical record for medications Hydration, Infusions, and Injections (HII) charged during observation time.  Know the resources for the HII hierarchy.
• Reviews the medical record for Observation cases to perform verification of observation hours and appropriate charges on claims.
• Captures appropriate charges in accordance with CMS billing rules and regulations.
• Other duties as assigned.

Education:

• High School Diploma / GED or equivalent required.
• Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college.
• Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

Certifications:

• Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) by American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by American Academy of Professional Coders (AAPC) is required and must be maintained.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking and analytical skills, decisive judgment and work with minimal supervision.
• Requires excellent communication skills to be able to converse with the clinical staff.
• Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

Work Experience:

• Minimum of 3 years coding to include 1 year of complex coding experience in a health care environment and or medical office setting required.
• Must demonstrate and maintain accuracy and proficiency in coding and claims editing to be considered for a Professional Coder III position.
• Internal candidate must currently be employed as a Professional Coder II at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of a Professional Coder II.

Physical Requirements:

• Typical physical demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard.
• Manual dexterity required to locate and lift medical charts.
• Ability to work under stress and to meet imposed deadlines.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.