Responsible for ensuring accuracy as well as verifying completed and precise medical record(s) for the interpretation of clinical documentation completed by the medical staff to correctly assign appropriate ICD10, CPT and/or HCPCS codes for professional coding. Coders for Steward Medical Group are part of a national team, with each Coder assigned to a specific geographic area, specialty and/or provider as per the needs of the company.
- Maintain department processes and controls according to Professional Coding Standards, CMS Standards, HIPAA, OIG, and the State guidelines as well as national payor coding guidelines as they pertain to professional coding and reimbursement.
- Communicate with providers and practices to ensure accuracy on all documentation and encounter forms, including follow-up with the provider and/or clinical staff on documentation that is insufficient or unclear.
- Complying with medical coding guidelines and SMG policies. Ensuring codes are accurately assigned and sequenced correctly in accordance with government and insurance regulations.
- Demonstrate understanding of National and Local Coverage Determinations as per MAC region.
- Ability to maintain the confidentiality of PHI as per HIPAA and SMG requirements.
- Exhibit sound knowledge of anatomy and physiology, medical terminology, surgical terminology, pharmacological terminology, patient care documentation terminology.
- Researching information in cases where the coding is complex or unusual. Disseminate information regarding new or updated codes and/or coding policies either by payer or through guidelines and regulations.
- Demonstrate basic knowledge of the Revenue Cycle and the impact of coding decisions on revenue cycle.
- Reviewing and processing insurance denials, analyzing Explanation of Benefits (EOB) forms to ensure insurance companies have properly paid for charges. Identifying denial trends and forwarding to coding management.
- Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing.
- Serve as a resource and subject matter expert to other coding staff in the resolution of intermediate problems and issues.
- Reviews medical records and identifies documentation deficiencies.
- Provide training as needed, including training of newly hired coders. Educate and mentor others to improve medical coding quality.
- Top applicants are motivated, detail-oriented, and have outstanding people skills.
- Maintain current credentials through continuing education CEU’s as per certification requirements.
- Other duties as assigned.
REQUIRED KNOWLEDGE & SKILLS:
- Demonstrated coding (ICD-10-CM, CPT and HCPCS) expertise. Ability to pass post-interview coding test.
- Computer literacy of medical information systems, records management software, encoders.
- Good computing knowledge in Microsoft Outlook, Word, Excel, PowerPoint etc.
- Excellent communication and customer service skills, both verbal and written.
- Understanding of third party reimbursement rules and regulations. Medical Billing experience preferred.
- Outstanding organizational, detail oriented and time management skills.
- Ability to work independently as well as part of a team when necessary.
- Excellent typing and 10-key speed and accuracy.
- Current medical coding certification CPC, CCS-P, RHIA or other nationally recognized coding credential.
- 5-10+ years of work experience as a medical coder. Professional Physician (ProFee) coding experience, preferred.
- 2+ years of medical billing experience, preferred.
Steward Health Care is the largest private, for-profit health care network in the United States. The company is owned and led by a management team of Steward physicians. Headquartered in Dallas, Texas, Steward employs more than 40,000 health care professionals and operates 35 hospitals across the United States and in the countries of Malta and Colombia which regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, more than 7,000 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.
The Steward Health Care Network includes more than 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters annually. Steward Medical Group, the company's employed physician group, provides more than six million patient encounters per year. The Steward Hospital Group operates hospitals in Malta, Colombia and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit www.steward.org.
Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.
Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and mask policy is required for patient and colleague safety.