FacilityCape Fear Valley Medical Center
LocationFayetteville, North Carolina
DepartmentPhysician Financial Services
Job FamilyProfessional
Work ShiftDays (United States of America)
SummaryThoroughly review medical records to code specifically and accurately those conditions or diagnoses that were treated or affected the patient's plan of care. Verify each medical record reviewed contains appropriate documentation to justify the selected CPT, HCPCS, modifiers and ICD-10 codes. Work with Physician Billing Office and physician practices to improve code assignment, resolve and prevent edits and review for documentation deficiencies. Help educate and develop professional coding within the CFV Medical Group and Physician Business Office.
Major Job FunctionsThe following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time:
- Work closely with CFV Medical Group/Ambulatory practices and Physician Revenue Cycle/Business Office to ensure CPT, ICD-10 and modifier usage is accurate on claims
- Assist overall goal to reduce coding related denials and improve coding related editing
- Assist and advise Business Office on coding related denials by reviewing medical record documentation to make corrections and/or adjustments to claims as needed
- Assess NCCI and CCI edits as necessary to apply appropriate modifiers and work closely with Business Office to improve front end editing as needed
- Assist in identifying revenue opportunities within the Medical Group through the creation of Job Aids and instructional/educational materials
- Provide education and feedback to providers, coding staff and billing staff as needed to ensure documentation requirements are maintained and revenue is optimized
- Analyze providers’ coding profiles (E/M coding distribution) and documentation patterns to ensure that providers are confident with code selection and documentation requirements
- Support the development of professional coders and coding standards within the Medical Group and Business Office
- Coordinate with Revenue Integrity on identifying documentation gaps, potential revenue opportunities and supports documentation improvement efforts overall
- Make management team aware of problem issues, negative physician communication and/or other influences that impact effectiveness of job performance
- Other duties as assigned
Minimum QualificationsThe following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:
Education And Formal Training
- * Bachelor’s degree in health information management required OR 8 years’ coding experience in lieu of degree required
- CPC, CPMA, RHIA, RHIT, CCS or CCS-P or other equivalent credentials required
Work Experience
Knowledge, Skills, And Abilities Required
- * Understanding of medical terminology, anatomy and physiology and familiarity with medical record content
- In-depth knowledge of ICD-CM coding principles, LCDs/NCDs, HCCS and other coding conventions for professional documentation and claim submission
- Uses tact and diplomacy in communications with physicians and other CFVH personnel
- Excellent communication skills
- High degree of interpretation, analysis, planning, coordination, and organization of information
- Decisions require intense mental effort and consideration of reimbursement ramifications
- Utilize past experiences, practices and organization to accomplish goals
- Assign accurate codes using good judgment in a timely manner within broad guidelines
- Must be flexible
- Ability to concentrate in a busy, noisy, and crowded environment with demands and interruptions 75% of the time
Physical Requirements
- * Job requires computer literacy
- Speech, sight and hearing required as incumbent must work independently in effectively training and monitoring coding functions
- Long periods of sitting
- Near visual acuity required
- Motor coordination required to operate computer
CFVH-2026
Required Licenses And CertificationsCCS - American Health Information Management Association
Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity
