Experienced Professional Fee Analyst

Experienced Professional Fee Analyst

Job Title: Divisional, Professional Fee Analyst
Department: Coding
Reports To: Manager, Divisional Coding
FLSA Status: Exempt

Summary

To interpret and analyze professional/physician documentation for assignment of diagnoses/procedures and Evaluation and Management (E/M) codes. Assignment of codes are based on CMS, CPT/AMA coding guidelines. The Professional Fee Analyst will adhere to the AHIMA Ethical Coding Standards

Essential Duties and Responsibilities include the following:

  • Inpatient Coding: Ensures all patient charge capture utilizing LINK census and Daily Consult report. Concurrently reviews physician documentation (EMR/dictation) to assign appropriate diagnoses and E/M codes each day. Maintains and reconciles all divisions inpatient label logs to ensure charge capture and physician feed back. Reviews all encounters for quality/all elements of clean bill prior to release for billing. Maintain a time lag of no more than 7 days from date of service to coding and preparing for charge entry.
  • Cross training with other division(s) to ensure coverage and charge capture.
  • Maintains, daily, a Medical Record List to ensure timely charge capture.
  • Outpatient Coding: Reviews physician documentation (EMR/dictation) to assign appropriate diagnoses and E/M codes for all encounters by date of service. The Professional Fee Analyst will maintain a lag time (date of pick up from clinic to final coding) of no more than 5 business days.Reviews all encounters for quality/all elements of clean bill prior to release for billing.
  • Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes. Creates and maintains provider deficiency notices.
  • Reviews and corrects pre-bill TES edits in assigned work file pertaining to coding and medical necessity issues, twice a week.
  • Maintains divisional specific production quotas. Ensures all assigned work processed is timely and maintains a quality standard of no less than 98% accuracy.
  • Attends regularly scheduled division(s) meetings and submits summary of coding education and feedback to coding manager.
  • Involves and informs management of any recurrent or chronic documentation deficiencies by physician.
  • Maintains credentials through continuing education.
  • Attends regularly scheduled coding and department meetings.
  • Promotes the values of University Pediatricians by demonstrating behaviors supportive of a commitment to quality, respect and involvement, teamwork, open and effective communication, innovation and education, and effective resource use.
  • Other duties may be assigned.

Supervisory Responsibilities

  • This job has no supervisory responsibilities

Competencies

To perform this job successfully, an individual should demonstrate the following competencies:

  • Analytical – Collects and researches data.
  • Interpersonal Skills – Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control.
  • Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions.
  • Written Communication – Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
  • Diversity – Shows respect and sensitivity for cultural differences.
  • Ethics – Treats people with respect; inspires the trust of others; Works with integrity and ethically.
  • Organizational Support – Follows policies and procedures.
  • Judgment – Displays willingness to make decisions; Supports and explains reasoning for decisions.
  • Planning/Organizing – Prioritizes and plans work activities; Uses time efficiently.
  • Professionalism – Treats others with respect and consideration regardless of their status or position.
  • Safety and Security – Observes safety and security procedures.
  • Adaptability – Manages competing demands; Able to deal with frequent change, delays, or unexpected events.
  • Dependability – Follows instructions, responds to management direction; Takes responsibility for own actions; Completes tasks on time or notifies appropriate person with an alternate plan.
  • Initiative – Takes independent actions and calculated risks.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

RHIA, RHIT, CCS, CCS-P, CPC from an accredited college/vocational school.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills

Ability to work with basic mathematical concepts and the ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should have knowledge of Database software; Internet software; Spreadsheet software and Word Processing software.

Certificates, Licenses, Registrations

RHIT Registered Health Information Technician
or RHIA Registered Health Information Administrator
or CCS, CCS-P, CPC

Other Skills and Abilities

ICD-10 Coding knowledge and experience
CPT Coding knowledge and experience
Ability to read charts, read physicians notes

Other Qualifications

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to walk; sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.