Quest Diagnostics Incorporated Norristown , PA 19404
Posted 1 week ago
This position is primarily responsible for providing CPT coding, CPT modifiers, and ICD coding, which affects the manner in which the company bills claims to third party payers. This position has a high-level understanding of QLS, BFE and QBS and is able to problem solve complex CPT/ICD coding issues. Because of the high-level knowledge, this position works independently and is able to assist with projects to enable correct CPT/ICD coding.
The Medical Coding department assigns CPT codes to all tests offered and performed at Quest Diagnostics. It involves working with billing and third-party payers to ensure that CPT coding is appropriately implemented, including any required changes to payer billing set up, annual CPT code changes, and test methodology changes that require changes to CPT codes.
The ICD aspect of the department includes assigning ICD codes to patient bills which ultimately affects what ICD codes are added to patient medical records through information sent to third party payors and clients. Medical Coding maintains the implementation of yearly changes to diagnosis coding and ensures the accuracy of system updates to ICD coding on patient bills.
The CPT/ICD coding areas are crucial functions, as they directly impact reimbursement and create enforcement risk if not handled appropriately.
This is a Remote opportunity
Assigns CPT Coding on the test code pending list
Maintains multiple systems with CPT, modifier and ICD codes, logic and changes
Assists Optum360 Billing in resolving denials resulting from invalid or incorrect CPT coding and ICD coding
Assists with projects related to changes in CPT codes, ICD10 codes, modifiers and laboratory system requirements
Performs CPT Coding Audits of both standard and non-standard sites
Resource for CPT/ICD questions for Optum360 coders and Quest laboratories
Approves CPT coding requests for non-standard sites
Maintains the CPT Masterfile for use by non-Standard sites
Reviews quarterly National Correct Coding Initiative (NCCI) edits and annual Chapter 10 edits and determines with the Medical Coding Team what Quest tests are affected
Communication of CPT changes to non-standard sites as necessary
Ensures proper use of NCCI edits and use of modifiers
Develops CPT, ICD, NCCI and modifier tools for use by Quest and Optum360 as needed
Implements Z codes in the billing system when notified by Medical Affairs of new Z codes for Quest offerings
Supports the IR and audit teams with questions related to CPT or ICD coding
Supports Franchise, Operations, Database, Billing, IT on special projects related to CPT and ICD Coding, Denials, Z codes
Other duties as assigned by the Compliance Director
Required Work Experience:
At least 3 years of experience in the clinical laboratory, or Healthcare related field.
Proven ability to work in a fast-past, rapidly changing environment.
Knowledge:
Thorough understanding of health care coverage, payment and administrative policy, and its business impact on billing, operations and financials.
Physical and Mental Requirements:
Proven ability to work in a fast-past, rapidly changing environment
Work effectively both independently and within a team
Work in a virtual team environment
Interact professionally with colleagues within Compliance and in other departments
Perform a variety of job duties with frequent interruptions or distractions, often changing from one task to another
Adjust priorities quickly as circumstances dictate
Maintain composure under pressure
Learn and comprehend information important to the business
Comprehend and follow verbal or written instructions
Make informed decisions
Examine/observe details
Strong analytical skills
Problem solving and root cause identification skills
Demonstrated leadership skills including integrity, trustworthiness commitment, resilience, high energy and motivation
Effective oral and written communication skills
Other:
Thorough understanding of health care coverage, payment and administrative policy, and its business impact on billing, operations and financials
Demonstrated ability to manage multiple priorities/projects simultaneously
Complete projects while meeting goals within established time deadlines
Experience with project management
Technical competency including Excel, Word, Outlook, Laboratory and Billing systems
Understanding of the technical aspects of laboratory testing
Skills:
Excel, Word, Outlook, Laboratory or billing systems.
EDUCATION
Bachelor's Degree preferred
LICENSECERTIFICATIONS
AAPC Certified Professional Coder (CPC)(Required)
Quest Diagnostics Incorporated