The incumbent will be responsible for serving as the point of contact for all documentation andcoding-related questions that require in-depth research and/or troubleshooting. Assist management with redesign ofestablished standards and codes to optimize reimbursement and ensure compliance for services provided, as well asanalysis of claims for proper documentation and coding, in compliance with state and federal guidelines. The CodingSpecialist possesses a valid medical coding certification and accurately codes patient services into billing software tosubmit effective insurance claims. A vital member in guiding and mentoring staff in the revenue cycle department.
- Learn client medical specialties and services offered.- Provide feedback to providers and operational staff regarding denials, payments, coding, etc.- Maintain communication by facilitating meetings and providing frequent updates- Act as a resource for coding questions from a variety of departments including Revenue Cycle, ClinicalOperations, HIM and EHR Support- Assist in troubleshooting and/or conducting research when presented with difficult coding scenarios.- Analyze supporting medical record documentation for professional services to ensure that appropriate ICD-10-CM, CPT, HCPCS codes are assigned according to established correct coding guidelines and standards ofethical coding.- Perform ongoing review and tracking of insurance rejections/denials with coding discrepancies, contactinginsurance companies when necessary.- Consult with clinical providers for coding and documentation clarification when necessary.- Conduct prospective and retrospective clinical documentation and coding reviews.- Provide individual and group feedback and education to clinical providers, and other staff because of thecoding reviews and identified coding trends, in accordance with the established compliance plan.- When provider documentation issues are identified, work with clinical operations and compliance staff toimplement corrective action plans.- Attend clinic and department staff meetings to disseminate information and to become familiar withoperational issues within each business unit.- Work in conjunction with clinical operations team to evaluate special requests for review of appropriatecoding due to patient complaints, denials, rejections, incorrect coding, etc., and provide feedback toinquiring source.- Analyzes information about patient treatment, diagnosis, and procedures to ensure proper codingguidelines are met.- Demonstrates working knowledge of multiple coding systems, including ICD-10, Level 1 HCPCS, and Level 2HCPCS.- Performs other duties as directed or assigned.
1. Neat, professional appearance2. Exerts up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly in lift,carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time butmay involve walking or standing for brief periods of time.3. Requires expressing or exchanging ideas by means of spoken word, visual and auditory acuity.4. Able to communicate clearly over the telephone.Education/Professional:1. High School Diploma required; Associate degree preferred.2. Current medical coding certification (CPC CCS, or CEMC) required.3. Three -Five years minimum of active coding experience required.4. Strong E/M coding experience, with focus on ICD-10-CM highly required.5. Hierarchical Condition Category (HCC) experience preferred.Knowledge, Skills and Abilities Required:1. Proficiency in the use of Microsoft Office applications and internet resources.2. Communicates effectively both orally and in writing.3. Ability to analyze, interpret, and draw inferences from research findings, and prepare reports.4. Ability to use independent judgment to manage and impart confidential information.5. Excellent attention to detail.6. Ability to establish and maintain effective working relationships with providers, management, staff, and contactsoutside the organization.
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