Position Summary

Responsible for research, management and resolution of pre-bill edits, and pre-bill errors. Conducts and or facilitates any other activities related to regulatory related coding requirements reviews, denials, surgery reservation CPT/PCS code(s) assignment and patient inquiries requiring coding review.

Essential Functions

• Reviews claims edits, from different source systems, via assigned work queues, leveraging coding and regulatory expertise, enabling cases to be successfully processed in a timely and accurate manner.
• Prepares material through research of coding and/or payer guidelines for claims denials. Reviews coding and recommends updated coding changes and/or provides appeal documents to follow up Team.
• Responsible for reviewing assigned surgery reservation forms and assigning appropriate CPT/PCS and ICD10 codes to initiate pre certification process.
• Reviews requests from the Customer Service department related to HIS coding disputes.
• Performs analytic reviews of encounters generated by vendors or other external sources.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. Maintains credentials. Maintains updated knowledge of regulatory guidelines and regulations affecting the coding field. Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Trending for potential edits and working with the Coding Educator to develop training and ongoing education based on identified needs.

Additional Responsibilities

• Participates in educational and informational activities.
• Participates in student mentorship programs.