Sr. Certified Coding Specialist / FT, Mon- Fri 8:00 - 5:00

Schedule: FT, Mon- Fri 8:00 - 5:00 At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities. A Brief Overview Performs a variety of tasks related to coding professional services including abstraction and assigning valid CPT, ICD10, and HCPCS codes for complex surgical cases, and/or coding verification and review to ensure coding accuracy and appropriate reimbursement in accordance with federal, state, and private health payer policies. Essential Functions

• 1. Review complex surgical reports for assign specialty, assigning and sequences CPT codes, modifiers, and diagnosis codes according to regulation (e.g., ICD10CM, CPT, HCPCS, UHDDS, and HIPPA coding guidelines) and/or abstract accurate clinical information to assign the most specific code possible to ensure an accurate health information database. Surgical Specialties to include Cardiothoracic, Neurosurgery, Orthopedics, Ophthalmology, Pediatric Surgery, Urology, Plastics, Cardiology (Cath/EP).
  • Appropriate assigning of surgical modifiers is critical as these impact reimbursement and provider compensation.
  • Meet with providers to review surgical cases as needed.
  • Based on surgical service maybe responsible to assure hospital technical and professional charges align.
• 2. Review and verify assigned codes for Evaluation & Management services, assign minor procedure and sequences diagnosis and procedures according to regulations (ICD10CM, CPT, HCPCS, UHDDS, and HIPPA coding guideline) and/or abstract accurate clinical information to assign the most specific code possible to ensure an accurate health information database. Contract physicians for clarification of clinics information as appropriate for account type as necessary.
  • Process encounters in coding work queue in a timely manner.
  • Enter charges into the practice management system.
  • Maintain date knowledge of coding and regulatory requirements to accurately assigned codes for appropriate reimbursement of health services. Continue to strive to meet continuing education requirements for certification or to maintain working knowledge of on-going changes to CPT, HCPCS, and ICD10 codes.
  • Utilize web-based tools, coding books, and other approved available resources to facilitate providing insurance companies with required information.
  • Utilize multiple information systems to accurately select the correct patient account in order to appropriately review and verify patient billable charges.
  • Participate in and assist with audits to capture lost charges and determine the accuracy of billing as necessary.
• 3. Identifies and communicates trends and educational opportunities to ensure proper documentation, coding, and accuracy of billing.
  • Trends identified from documentation and denials.
  • Provide input timely responses to coding related questions from the denials team.
  • Identify charge related edits that can be built in the practice management system to reduced denials.
• 4. Respond to inquiries from provider offices and various internal departments in a timely and accurate professional manner.
  • Demonstrate and support good relations between Children’s Hospital, the contracted providers, and the community.
  • Make inquires to other stakeholders on the accuracy of the information, as needed. Follow- up on pending requests when necessary
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or GED Required

Experience Qualifications

• Minimum 5 years of professional or hospital coding required with one- year surgical coding experience Preferred

Skills and Abilities

• Knowledge of medical terminology.
• Knowledge of billing CPT, HCPCS and ICD-10CM coding required.
• Knowledge of NCCI, NCD and LCD edits.
• Ability to type 40 words per minute with 99% accuracy.
• Ability to pay attention to detail.
• Ability to provide a pleasant and welcoming appearance to all with which you come in contact.
• Ability to read, write, type, and follow oral and written directions.
• Ability to work independently, effectively and efficiently performing assigned duties.

Licenses and Certifications

• Certified Coding Professional (CPC) Required or
• Certified Coding Associate (CCA) Required and
• Additional specialty coding certification, preferably through the AAPC, within 1 year required. Certain Continuing Education Units (CEU) may fulfill this requirement if AAPC does not offer specialty certification. within 1 Year Required

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