KPN Pro Fee Coding Specialist

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation.

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
• Reviewing the ambulatory records for the appropriate risk adjustment components
• Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes
• 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)