Edit Senior Coder

JOB SUMMARY 

This position will be functioning under minimal supervision while utilizing independent decision making. This position will assist the manager and supervisor in training new team members, coordinate inquiries from ancillary departments regarding DNFB and edit tasks.  The Sr. Edit Coder will investigate and solve edit issues and communicate root cause data to management in order mitigate potential upstream and downstream impacts.

Responsible for modifying and completing moderate to high complexity reviewing and resolving coding and charge edits using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA.  Abstracting required clinical information from the medical record.  Working in billing editor systems as required.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Performs claim edit reviews on outpatient encounters to validate appropriateness of the CPT codes, HCPCS Level II codes, and modifier assignments, APC group appropriateness, review for missed secondary diagnoses and/or procedures, and ensure compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Addresses CCI and LCD edits within the various billing editors while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Conifer’s Edit Coder productivity standards.
• Runs and submits coding operational reports to leadership as requested, reviews data and identifies opportunities or trends. Demonstrates working knowledge of DNFB and uses data to drive performance excellence. Ability to analyze, display, and communicate data in meaningful manner. Ability to maneuver thru various electronic systems effectively.
• Ability to deal with customer/partner issues and resolve conflict. Ability to multi-task and meet deadlines.  Will act as a resource for Edit Coders.
• Reviews claim denials and utilizes the medical record in determining accurate code assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.
• Monitors DNFB report for outstanding and/or uncoded encounters to ensure timeliness of coding completion. Brings identified issues to department managers for resolution.  

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Three years minimum hospital outpatient coding/edit experience 
• Advanced personal computing skills including MS Outlook, MS Word, MS Excel
• Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, and work efficiently in a virtual environment
• Strong written and verbal communication skills
• Ability to think/work independently, yet interact positively with team
• Advanced problem-solving skills and ability to quickly analyze a situation.
• Comprehensive knowledge of ICD-10 and CPT coding systems.
• Strong knowledge base of changes in LCDs and NCDs.
• Strong knowledge base of current NCCI and OCE guidelines
• Attention to detail is critical to this position
• Other functions as deemed necessary to complete and final bill claims accurately

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• Previous auditing experience or strong training background in coding and reimbursement 
• Outstanding interpersonal communication skills as well as excellent oral and written communication skills
• Comprehensive knowledge of the APC structure and regulatory requirements.
• Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures 

CERTIFICATES, LICENSES, REGISTRATIONS

Required:  AHIMA RHIT or RHIA or AAPC CCS, CPC approved credential<