Certified Coding SpecialistApply Now
High level understanding and ability to review/abstract appropriate CPT-4, ICD-10-CM, HCPCS and modifiers for patient encounters and procedures. Must also exhibit an of understanding of AMA, specialty specific coding/billing/auditing concepts & compliance guidelines (CMS/OIG/Federal/State regulations) to perform daily functions and assist other Teams with coding and billing workflows/questions. Daily use of various EMRs and other clinical, coding applications, along with Microsoft application (word, excel, outlook, etc.) is required.
Essential Job Functions:
- Monitoring and working work queues/dashboard for assigned providers and specialties, to include coding, researching, correcting claims and trending of coding/billing behaviors.
- Code all documented professional services provided in both clinic and other facilities
- Applies CPT-4, ICD-10-CM, HCPCS and modifiers following coding guidelines
- Adheres to official coding guidelines, AMA and CMS
- Expert in reviewing assigned providers/specialty areas and preparing educational communication, supporting documentation, etc. for provider and other Team coding/billing inquires
- Ensures coded services, provider charges and medical record documentation meet appropriate guidelines and standards
- Keeps abreast of coding guidelines and reimbursement reporting requirements
- Fields coding questions and ensures review of patient complaints as well as insurance related inquires on behalf of assigned providers and specialties as needed
- Illustrate knowledge of healthcare industry in areas of coding, revenue cycle, claims and state specific insurance/laws
- Ensure timely charge review/processing of daily submissions
- Works collaboratively with Team to ensure monthly goals are met
- Responsible for creating/updating reference tools for assigned specialties as needed (tip sheets/coding guidelines, etc.) -- review biannually is expected
- Provides feedback to physicians related to documentation issues and/or revenue opportunities
- Queries physicians when code assignments are not straightforward or documentation in the record in inadequate, ambiguous, or unclear for coding purposes
- Utilize appropriate application/methods to ensure all documented professional services are submitted timely
- Ability to work on assigned coding projects and compile summary reports as needed
- Ability to identify/trend/summarize potential compliance, coding, billing concerns and bring forth a potential resolution
- Other duties as assigned
Education, Certification, Computer and Training Requirements:
- High School Graduate/GED required. Associate's or Bachelor's degree preferred.
- Coding Certification(s): CPC, CCS-P, CCA, CCS or RHIT, RHIA- Required.
- Auditing, Compliance and Billing or Practice Management Certification(s): CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, CHA, CFE etc. -- Preferred
- 5+ years' experience preferred / 2 years minimum required.
- 1+ year auditing experience preferred
- Multispecialty coding exposure/experience preferred
- EMR experience required / exposure to various EMR's preferred
- Proficient use of Microsoft Office Applications (Excel, Word, Outlook, Skype) and another telecommunication applications (e.g. Go to Meeting)
Physical Job Requirements:
- Sitting long lengths of time
- Extensive use of computer / other applications, including phone
- Ability to multi-task, organize & prioritize work
- Ability to work in confined and/or various workstations
- Ability to work with diverse personalities
- Ability to work remotely
- Travel using personal vehicle may be required to various locations (more than 1 mile)
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