Coder III, Orthopaedics, Remote

GENERAL SUMMARY/ OVERVIEW STATEMENT:

The Coding Specialist III 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 III is required to:

Perform coding and related duties of high complexity work using established Professional Billing Office and Coding Services policies and procedures in an accurate and timely manner. Review complex and unique 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. (May occasionally code low or moderate complexity work as needed or requested by manager)

Research, understand, and interpret complex billing rules and regulations for new and existing procedures.

Ability to explain critical thought processes and justification for complex coding scenarios to internal and external stakeholders including physicians, clinical staff, and leadership.

Demonstrate a commitment and ability to integrate coding compliance standards into daily coding practices. Identify, correct, and report coding problems.

Maintain current requirements of coding, compliance and reimbursement rules and regulations. Review current literature, newsletters, payor policy updates and coding manuals.

Resolve highly complex coding edits and denials in a timely manner. Identify and suggest opportunities to reduce denials and enhance revenue.

Provide cross coverage of multiple complex specialties

Function as a subject matter expert to Professional Billing Office staff and external customers. Research and resolve 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 other 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.

KILLS/ 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 high complexity work. (May occasionally code medium or low.)

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 various group sessions as needed or requested. Able to provide education with physicians in various size group sessions as needed or requested.

Able to provide feedback to billing managers, physicians, staff, and others independently without guidance from manager.

Able to provide cross-coverage of multiple complex 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 and computer skills required.

QUALIFICATIONS: ( MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

• 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.
• Additional coding certifications preferred (Specialty and/or related) but not required.
• Completion of a Coding Certificate program or Health Information Technology Program or >2 years work experience equivalent required.
• A Minimum of 5 years of experience in coding required.

MGB is an Affirmative Action Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.