This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance and EPIC WQ Reconciliation.
KPN Pro Fee Coding Specialist
Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.
- Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits
- Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10
- Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]
- Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
- Corresponds with providers on pending claims to facilitate resolution
- Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies
- Communicate appropriately with providers, leaders, and staff
- Researches and resolves concerns timely