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-10 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-9 coding areas are crucial functions, as they directly impact reimbursement and create enforcement risk if not handled appropriately.
Duties and Responsibilities:
• Assigns CPT Coding on the test code pending
• Maintains multiple systems with CPT, modifier and ICD 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-10 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
• BS Degree in Healthcare discipline or related field, or equivalent combination of education and experience
• AAPC certification or AAPC certification eligible preferred.
• 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
• 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
• 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