Coding Specialist

Description

SECTION 1: Job Summary (Summary of the basic functions of the position)

Responsible for determining if applied coding matches provider documentation in the EHR. Be able to
identify coding and documentation discrepancies. Clearly communicate and educate Providers and clinic
staff on proper coding and billing guidelines when necessary. Follow approved processes, policies,
procedures and coding guidelines in executing job duties.

SECTION 2: Duties and Responsibilities (Responsibilities necessary to accomplish job functions)

• Compiles daily work list from NextGen tasking system and/or other systems/reports and takes action to resolve work daily following established procedures and thresholds
• Communicate with insurance companies about coding errors and disputes.
• Review claim edits for correct coding.
• Review claim forms for accuracy and correct coding.
• Retrieving and submitting appropriate medical records as needed.
• Utilize problem-solving skills to research and resolve discrepancies, denials, appeals.
• Review payer rules to understand reason for denial.
• Interpret clinical documentation to determine services provided.
• Compose correspondence to payer regarding payment disputes and/or appeals.
• Apply knowledge of coding guidelines to properly evaluate clinical documentation.
• Effectively communicates with physicians, nurses, and other healthcare professionals to classify the services a patient has received.
• Perform follow-up actions with insurance companies to ensure timely and full payment
• Actively participates in problem identification and resolution.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Qualifications

SECTION 3: Knowledge, Skills and Abilities Requirements

• Professional in appearance and actions
• Logical and Critical thinking skills
• Customer-focused with excellent written, listening and verbal communication skills
• Infatuation with learning new technologies and systems
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of CPT and AMA guidelines as well as ICD-10, CPT and HCPCS.
• Knowledge of claim forms HCFA 1500 and UB 04
• Detail oriented, professional attitude, reliable
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and team mate support needs
  • Able to communicate effectively in English, both verbally and in writing
• Mathematical and/or analytical ability for basic to intermediate problem solving
• Basic to intermediate computer operation
  • Proficiency with Microsoft Excel, Word, and Outlook
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

SECTION 4: Supervisory Responsibilities:

• This position has no supervisory responsibilities.

Salary : $25 - $29