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Senior Certified Coding Specialist

Job ID 10492852 Date posted 01/10/2019

Position Summary:

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. This position will run reports to perform daily coding abstracting and auditing functions for charge capture. 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
Job Requirements

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

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)



  • Travel using personal vehicle may be required to various locations (more than 1 mile)

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