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Pro Fee Coding Spec – Prestige Place – HIM – Full Time – Days

Kettering Health

This is a Contract position in Exton, PA posted September 3, 2021.

Overview: Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio.

We are committed to transforming the health care experience with high-quality care for every stage of life.

Our service-oriented mission is in action every day, whether its by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Responsibilities & Requirements: This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation.KPN Pro Fee Coding SpecialistServes as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI editsAccurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI editsCorresponds with providers on pending claims to facilitate resolutionResponsible for participating in departmental goals, KHN mission and implemented KHN/KPN policiesCommunicate appropriately with providers, leaders, and staffResearches and resolves concerns timelyEducational Requirements:High School Diploma or equivalentRHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certificationPrior experience in professional fee coding/billingKnowledge and Skill:CPT, HCPCS, Modifiers, ICD-10, and CMS NCCI EditsMedical Terminology and Anatomy & PhysiologyComputer and EPIC ApplicationsExcellent verbal and written communication skillsAbilities:Charge Review WQ [Edits]Reviews, researches and responds to Charge Review WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI editsClaim Edit WQ [Edits]Reviews, researches and responds to Claim Edit WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI editsFollow Up WQ [Denials]Reviews, researches and responds to Follow Up WQ edits pertaining to coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Corresponds and communicates appropriately with providers on coding, CMS NCCI edits, and/or medical necessity requirements to facilitate resolution.Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI editsDepartmental ResponsibilitiesResponsible for participating in departmental goals, KHN mission and implemented KHN/KPN policiesDemonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI editsFollow procedures pertaining to positionResearches and resolves concerns timely