Changing health care
to improve quality of
life for all.
Beth Israel Lahey Health’s roots in providing top-quality health care date back nearly a century. We're fully committed to ensuring our patients receive the care they deserve. As a leading healthcare provider throughout New England, we aim to change the current state of health care for the better and make lasting improvements that guarantee access to our services.
CPC Certified Coder (Physicians' Denials)
Burlington, MassachusettsOrganization Facility: Beth Israel Lahey Health Category: Billing, Collections, & Patient Financial Services Job ID: JR11280 Date posted: 01/20/2023
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Work Shift:Day (United States of America)Responsibilities include hands on coding, documentation review and other coding needs for ICD-10 coding of any coding related denied professional services for appropriate use of CPT, ICD-10, HCPCS, Modifier usage/linkage. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and coding denials through independent research and assigned projects. CPC certification required.
1. Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
2. Review of obtained authorizations for any related denied professional services due to authorizations without a matching CPT, ICD-9, ICD-10, HCPCS, modifier. Provides updated coding when applicable.
3. Periodic review of codes, at least annually or as introduced or required.
4. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
5. Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
6. Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
7. Maintains certification requirements for coding.
Follow Up Responsibilities:
1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
2. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
3. As needed reviews all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature.
4. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Coding and Billing Supervisor.
5. Handles incoming department mail as assigned.
6. Attends meetings and serves on committees as requested.
7. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
8. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
9. Assists the Coding and Billing Supervisor with the resolution of complex claims issues, denials and appeals.
10. Completes projects and research as assigned.
11. Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
1. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
2. Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
3. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
4. Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
5. Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
6. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
7. Assists other staff as required in the completion of daily tasks or special projects to support the department’s efficiency.
8. Performs similar or related duties as assigned or directed.
Education & Professional Development
1. Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD’s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
2. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
3. Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
1. Maintain strict adherence to the Lahey Health Confidentiality policy.
2. Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
3. Comply with all Lahey Health Policies.
4. Comply with behavioral expectations of the department and Lahey Health.
5. Maintain courteous and effective interactions with colleagues and patients.
6. Demonstrate an understanding of the job description, performance expectations, and competency assessment.
7. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
8. Participate in departmental and/or interdepartmental quality improvement activities.
9. Participate in and successfully completes Mandatory Education.
10. Perform all other duties as needed or directed to meet the needs of the department.
Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
Licensure, Certification & Registration:
CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
1-2 years of experience in billing, coding, denial management environment related field.
Skills, Knowledge & Abilities: ·
Ability to work independently and take initiative · Good judgment and problem solving skills · Excellent organizational skills · Ability to interact and collaborate effectively and tactfully with staff, peers and management. · Ability to promote team work through support and communication.
· Ability to accept constructive feedback and initiate appropriate actions to correct situations. · Ability to work with frequent interruptions and respond appropriately to unexpected situations.