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Form of workGENERAL SUMMARY/ OVERVIEW STATEMENT:
The Coding Specialist II reports to the Supervisor/Coding Manager/Senior Coding Manager and is responsible for correct coding of professional services and upholding compliance standards.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
The Coding Specialist II is required to:
Perform coding and related duties of moderately complex work using established Professional Billing Office and Coding Services policies and procedures in an accurate and timely manner. Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements as defined in Billing Area Instructions or Standard Operating Procedures. (May occasionally code high or low complexity work as deemed capable and requested by manager)
Research billing rules and regulations for moderately complex new and existing procedures
Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems.
Maintain current knowledge of coding, compliance and reimbursement procedures. Review current literature, newsletters, payor policy updates and coding manuals.
Resolve moderately complex coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
Provide cross coverage of multiple specialties
Function as a resource to Professional Billing Office staff and external customers. Research and resolve moderately complex coding inquiries. Make recommendations for coding policy changes.
Participate in annual code updates, understanding of new codes, and notification to practices and other CPBO staff of new code updates.
Perform peer to peer quality assurance reviews of all Coding Specialists in equal or lower complexity areas of expertise.
Functions as subject matter expert for assigned specialties
Develop and maintain division specific coding procedures and/or billing area instructions.
Complete special projects as assigned by manager.
Participate in coding education for providers and co-workers upon request.
Maintain coding certification.
QUALIFICATIONS:
High school diploma required
Course work in anatomy and physiology, medical terminology strongly preferred.
Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, CCS, CCS-P. (>15 years actual coding experience may substitute for the required core coding certification)
Advanced Specialty or additional related certifications preferred but not required.
Completion of a Coding Certificate program or Health Information Technology Program or >2 years work experience equivalent required.
A Minimum of 2 years of experience in coding required.
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
- Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.
- Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
Able to code medium/moderately complex work. (May occasionally code high or low complexity work as deemed capable and requested by manager)
Understands, retains, and is able to research coding billing rules, regulations, and requirements.
Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
Able to share/transfer knowledge or train co-workers, peers, billing managers on coding - Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
Able to provide cross-coverage of multiple specialties.
Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
Accuracy and attention to detail
Proficient with computer applications (MS Office etc), Excellent data entry skills
WORKING CONDITIONS:
The Professional Billing Office is located in the Charlestown Navy Yard campus. Most work is expected to be done remotely, however employee is expected to travel onsite as requested.
SUPERVISORY RESPONSIBILITY: List the number of FTEs supervised.
N/A
FISCAL RESPONSIBILITY:
N/A
