Summary

Job Description

The Gastroenterology (GI) Coding and Revenue Cycle Specialist is responsible for supporting professional billing, coding, and accounts receivable functions aligned with gastroenterolgoy for Penn Medicine Lancaster General Health. This position serves as a first point of contact for coding inquiries and acts as a resource to gastroenterology providers for coding issues and education. The GI Coding and Revenue Specialist helps to optimize revenue through appropriate coding while adhering to official coding guidelines for the purpose of assuring accuracy and compliance when billing insurance carriers.

HOURS: 40 hours/week working remotely

To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospital and outside agency requirements. This includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record. This position is an integral part of the revenue cycle as it pertains to physician coding and billing functions, as such will interact with physician and non-physician providers to maximize correct coding initiatives. Responsible for analyzing and resolving issues of missing charges and problem accounts by researching information regarding department reimbursement.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

Perform systematic reviews of professional fee billing and coding for non-governmental carriers using an established point system ensuring that documentation supports billed services. Ability to educate providers from research and audit findings as needed. Compiles and prepares materials for meetings as necessary; ensures accuracy of information provided. Prepare and present coding education to new providers joining the practices to ensure understanding current evaluation and management guidelines Identify patterns in denials working with appropriate parties to correct errors and mitigate future errors. Researches topics with the capability to interpret complex rules and regulations. Keeps abreast of CPT coding changes Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process. Monitors on an on-going basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed. Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts. Prepare and present coding education to new providers joining the practices to ensure understanding current evaluation and management guidelines Review and resolve charges in work queues based on payer edits, CCI edits, and coding-related denials Collaborate with customer service department to resolve coding-related patient complaints

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Monitors payer guidelines to ensure accurate coding, including local Medicare Administrative Contractor guidance, state payer rules, regulations, and trade publications.
• Assist the team with occasional special projects
• Other duties as assigned

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

High school diploma or equivalent (GED) Formal education in ICD-10-CM coding, CPT-4 coding, and medical terminology Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), COC-A (Certified Outpatient Coder-Apprentice), COC (Certified Outpatient Coder), Formerly CPC-H (Certified Professional Coder-Hospital), or CIC (Certified Inpatient Coder). Certification as Qualified Medical Gastroenterology Coder (QMSC), Certified Coding Specialist for Physicians (CCS-P) or a Certified Professional Coder (CPC). If not certified, coding certification is required within three (3) years of employment/ Two years of practical coding experience

PREFERRED QUALIFICATIONS:

Experience with electronic health records, preferably EPIC. Extensive experience with coding software products. Experience with technical writing/report writing. One (1) year experience with Epic Three (3) to five (5) years’ experience with physician billing

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.

Disclaimer