Coding Specialist
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Job Location:
Monthly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Overview
Coding Specialist
The Coding Specialist plays a critical role in ensuring accurate coding compliance and reimbursement for the Department of Surgery.
Primary Responsibilities:
Coding & Reimbursement: Reviews provider documentation and assigns the most accurate ICD-10 and CPT codes at the highest level of specificity to ensure appropriate billing and maximize reimbursement from third-party payors.
Compliance & Education: Supports physician and staff education on EVMS Medical Group Compliance Guidelines HCFA Teaching Physician Guidelines and industry coding standards. Provides feedback based on results of chart audits.
Auditing & Documentation Review: Assists with internal departmental mini-audits to confirm that inpatient and outpatient medical records contain sufficient documentation to justify the type and frequency of billed services.
Revenue Integrity: Ensures charges are submitted accurately and compliantly directly impacting the Departments ability to optimize revenue while minimizing risk.
Departmental Impact:
This position is essential to maintaining financial accuracy compliance with federal and institutional guidelines and safeguarding the Departments reimbursement streams. By bridging clinical documentation compliance and billing the Coding Specialist helps protect the Department from compliance risk while strengthening overall revenue performance.
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES
Conduct monthly provider and staff coding and compliance education classes as needed/requested.
Assist with recommendations on implementing procedures for compliance within the surgery setting.
Assist as needed to develop Surgery compliance coding and billing policies and procedures based on the EVMSMG Compliance Plan and the HCFA Teaching Physician and work monthly denials and Medical Group Spread sheetsProcess/key physician charges
Ongoing review of compliance coding and billing literature and guidelines effecting academic medicine and surgery practice.
Performs internal quality assurance charge/chart audits in a timely and consistent manner on both outpatient/inpatient services and surgical services.
Researches and assign the appropriate CPT/ICD-10 code based on the physicians dictation and other medical records to ensure that the most accurate combination of codes is used for each patient.
Audits and reviews the appropriateness of the CPT and ICD-10 coding selections assuring that the appropriate link between the two coding procedures has occurred.
Functions as liaison between the physicians the data entry staff and the Medical Group Billing Office to communicate and/or educated regarding the appropriate use of the procedural and diagnostic coding process.
Review monthly charge allowance reports to ensure utilization of appropriate fees in such a manner that reimbursement is maximized.
Supervise the charges being entered into patient record adhering to carrier regulations.
Each record reviewed for quality and content with special emphasis on:
- History and examination
- Procedure and diagnostic linkage
- Medical decision making
Completes and follows up on missing Information from Physicians when the information provided does not support the services rendered.
Coordinates the activity of coding and data entry to ensure their accuracy as they relate to the billing process
Review H&P and surgeons documentation for coding and abstracting of patient encounters including diagnostic and procedural information significant reportable elements and complications.
Researches and analyzes data needs for reimbursement.
Analyzes medical records and identifies documentation deficiencies.
Serves as resource and subject matter expert to other coding staff.
Reviews and verifies that documentation supports diagnoses procedures and treatment results.
Identifies diagnostic and procedural information.
Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
Assigns codes for reimbursements research and compliance with regulatory requirements utilizing guidelines.
Follows coding conventions. Serves as coding consultant to care providers.
Identifies discrepancies potential quality of care and billing issues.
Researches analyzes recommends and facilitates plan of action to correct discrepancies and prevent future coding errors.
Performs other duties as assigned.
Qualifications
EDUCATION and/or EXPERIENCE:
Associate degree
Candidate must have 4 years prior experience working with CPT/ ICD-9 & ICD 10 coding is required including having a comprehensive understanding of all insurance types and requirements. Current CPC certification is required and must be maintained annually. Surgery coding experience a plus.
Location : Location
Required Experience:
Unclear Seniority
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Eastern Virginia Medical School (EVMS) offers medical degrees, residencies, and specialty programs in areas such as art therapy and clinical embryology. The community-oriented school does not have a teaching hospital but rather partners with about 10 regional hospitals and clinics. It ... View more
