Department: Actuarial Services - Geisinger Health Plan
Work Type: Full Time
Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form such as ICD-9-CM, and ICD–10-CM, codes that can be utilized for submitting accurate and complete claim encounter information for reimbursement. Performed by specially trained professionals, medical coding provides information for billing and reimbursement, gathering statistics, reporting and marketing. Follows established hospital and professional coding guidelines and utilizes Coding clinic, CCI, CPT Assistant, Natural Language Processing Technologies and other resources to ensure compliance with national and federal coding guidelines.
As a group, this position is responsible for coding all risk-adjustment eligible lines of business (Commercial Exchange/AON Exchange, Medicare, Medicaid, CHIP) to ensure accurate reimbursement and contribute to the overall fiscal health of the organization.
Reports to Manager, Risk Adjustment, Actuarial Services
COMPETENCIES AND SKILLS:
• Competency in the use of computer applications including multiple EMR systems, Encoder, and all coding and abstracting software/hardware currently in use by The Health Plan
• Updated skills required for the ICD-10-CM and ICD-10-PCS coding system
• Advanced skills in extracting and analyzing clinical documentation
• Superior knowledge of anatomy and physiology along with disease pathophysiology
• Thorough understanding and application of new and expanded coding guidelines for both ICD-10-CM and ICD- 10-PCS
• Adheres to all code of conduct and organization-wide rules as a representative of the department
• Analytic skills necessary to clinically assess medical records
• Excellent prioritization and organizational skills
• Ability to work with minimal supervision at a high level of accuracy and productivity
• Ability to communicate both verbally and in writing in a highly professional manner
• Ability to be punctual and maintain an excellent attendance record
• Ability to be articulate, mature, and highly organized
• Ability to have close attention to detail viewing a computer monitor, reading reports in electronic format, and reading physician handwriting
• Ability to meet deadlines and function under pressure
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
EDUCATION AND/OR EXPERIENCE:
High School Diploma or GED required.
Minimum of three years coding experience in an acute care hospital or outpatient clinic setting required.
College level course work in coding to include ICD-10, CPT 4, medical terminology, human anatomy and physiology and minimum two years coding experience in an acute care hospital or outpatient clinic setting required.
Prior experience with and/or use of an encoder preferred.
CERTIFICATION: Requires one of the following credentials CPC, COC, CIC, CCA, CCS, CCS-P, RHIT, RHIA
If suitable candidate cannot be found, applicants who meet basic qualifications and experience for a lower level position will be considered for hire at a lower level. Salary would commensurate with education/experience.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Travel is required.
Work is typically performed in an office environment
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.