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Position Details

Department: Profee Coding Educ & Auditing
Category: Hlth Info Mgmt/Med Records
Location: Phoenix
Posting #: 477834
Date Posted: 9/27/2019
Employee Type: Regular

Position Summary

Under direct supervision of the Manager of Professional Services, performs audits of medical records for compliance with federal coding regulation and guidelines. Uses knowledge of PCH policies and procedures to provide a second level review of all Codes (CPT, EM, ICD-10 etc.) to achieve and maintain compatibility with Government and PCH billing requirements and compliance standards. This position collaborates with Coding Educator to provide training and education to Coding and Medical Staff. This position also assists with coding production, as needed; reviews and resolves coding issues related to billing; researches complex coding issues and participates in process improvements related to coding and EM management.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
    • Audits medical record documentation to identify under/over coding.
    • Maintains current department policies related to coding and documentation requirements.
    • Researches and resolves complex coding/documentation issues.
  2. Performs internal coding and documentation quality reviews of coded Ambulatory services and professional fee assignment of medical records to verify the accuracy and specificity of assigned codes in accordance with documentation guidelines.
  3. Communicates with providers regarding medical record documentation in order to maximize accuracy, completeness, and compliance with accepted standards of practice and current coding guidelines.
  4. Reviews accounts, when requested by the Physician Billing and Revenue Cycle Department and other clinical departments to research and resolve coding issues related to billing.
  5. Participates in continuing education activities to maintains current credentials, as well as to enhance knowledge and skills.
  6. Reviews Medical records for appropriate Diagnosis/EM/CPT/HCPCS codes and modifiers in compliance with Official Documentation Guidelines for Coding and Reporting as well as PCMG coding policies.
  7. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. High School Diploma or equivalent. Required
2. Associates Degree in Coding or related field Preferred
Do you meet this requirement?
Experience
1. One year of Physician E/M Auditing experience. Required
2. Comprehensive knowledge of ICD-10-CM Official Guidelines for Coding and Reporting, ICD and CPT/HCPCS coding classification systems, including facility and physician E/M, and hospital coding and reimbursement software. Required
3. Previous experience interacting with external coding auditors. Preferred
4. Staff training experience in a healthcare setting. Preferred
Do you meet this requirement?
Certifications/Licenses/Registries
1. CPC, CCS-P, CCS or RHIT Required
2. CPMA Preferred
Do you meet this requirement?
Special Skills
1. Previous work with Auditing software. Preferred
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Frequently
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Constantly
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Frequently
11. Physical Requirement - Walking Frequently
12. Physical Requirement - Near Vision Constantly
13. Physical Requirement - Far Vision Constantly
14. Physical Requirement - Color Discrimination Occasionally
15. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
16. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
17. Occupational Exposure/Risk Potential - Inside office environment Applicable
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply