PRIMARY FUNCTION

The Coding Specialist is responsible for reviewing and applying applicable diagnosis, procedure codes, and modifiers as needed, in adherence with departmental policies for services provided by physicians and allied health providers and provide training and guidance to providers.

Manage program for high-quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-10, CPT-4, and HCPCS coding classification systems, to meet billing system requirements. Manage the internal quality coding audit program.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

• Support the collections department to maintain the expected level of quality from a coding perspective. This includes reporting trends and recommendations for potential quality enhancements.
• Audits medical record documentation to identify under-coded and up-coded services and prepares reports of findings to include:
• Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
• Researches, analyzes, and responds to inquiries regarding inappropriate coding, denials, and billable services. Correction of daily coding errors/denials.
• Meet and maintain all departmental and personal production goals as directed by the Manager. Communicates areas of improvement from a provider documentation standpoint and creates formal recommendations.
• Participates in the ongoing review process, as directed by the Manager to assure the accurate application and coding of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-10), and/or the Health and Care Professional Council (HCPC) codes, the capture of all services provided, and that services which were not performed are not billed for.
• Other duties as assigned.

QUALIFICATIONS

EDUCATION:

High School Diploma or equivalent required. Experience may commensurate education.

EXPERIENCE:

Minimum 3 years of experience required. Experience in chart auditing in multi-specialty physician coding preferred.

LICENSURE / CERTIFICATION

CPC, CPC-H, CCS, CCS-P, CPMA or RHIT Certificates preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of billing and coding policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.).
• Skilled in defining problems, collection of data, interpreting billing information and provider documentation.
• Ability to communicate effectively and clearly.
• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Detailed knowledge of medical coding systems, procedures, and documentation requirements.
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
• Ability to provide guidance and training to professional and technical staff in area of expertise.

TYPICAL WORKING CONDITIONS

• Non-patient facing
• May be either full time remote/telework or rotate working in the office and remote/telework.
• This job must be U.S. based.
• Indoor Work
• Operating computer
• Reach Outward
• Manual dexterity
• Lift/Carry 20 lbs. or less.
• Sitting

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.