Sutter Health Coding Analyst I-Coding & Reimbursement-Sunnyvale in Sunnyvale, California

Description

Job Summary: Under minimal supervision, review charge review edits (errors) in relation to correct coding of physician services. Review documentation of services, coding rules, and use coding tools to resolve edits. Employee will also research and resolve coding denials via Epic work queues (follow-up), and process charge corrections based on established protocols &/or as directed by the management staff.

Responsibilities:

  • Charge Review : Resolve Claims Manager and Epic Edits to ensure correct coding of services provided. This includes review of documentation for correct coding and E/M leveling, diagnosis coding, bundling issues, modifier usage, etc.

  • Follow-Up: Review and correct charge sessions in the Follow-Up WQs if coding changes are appropriate for resolution of claim denials. This requires knowledge of correct coding and payer rules, research of billing requirements and documentation review.

  • Problem Solving/Process Improvement: Evaluation of current processes for improvement; including charge review edits, policies and procedures, and denial trends. Identification and recommendation of solutions.

  • Provider/Staff Feedback: Maintain excellent customer service and professionalism in written and verbal communications when interacting in the workplace.

  • Knowledge: Maintain knowledge of medical coding and documentation standards, including CMS documentation and billing guidelines, CPT-4, ICD-9-CM, ICD-10-CM and HCPCS.

  • Perform other duties as assigned.

Qualifications

REQUIRED: high school diploma or equivalent;; must have at least (1) one year of prior medical billing experience; must be able and willing to travel as needed to different PAMF sites; must have above average knowledge of Word, Excel and PowerPoint; CPC-A or CPC certificate

PREFERRED: AA degree in Business or Healthcare, or equivalent years of related experience; working knowledge of Microsoft Access; clinical background (MA, LVN, etc)

Primary Location: California, Peninsula/South Bay and Santa Cruz, Sunnyvale

Organization: Palo Alto Medical Foundation

Employee Status: Regular

Benefits: Yes

Position Status: Non-Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.