This position is primarily responsible for providing CPT coding, CPT modifiers, and ICD coding, which affects the manner in which the company bills claims to third party payers. This position has a high-level understanding of QLS, BFE and QBS and is able to problem solve complex CPT/ICD coding issues. Because of the high-level knowledge, this position works independently and is able to assist with projects to enable correct CPT/ICD coding.

The Medical Coding department assigns CPT codes to all tests offered and performed at Quest Diagnostics.  It involves working with billing and third-party payers to ensure that CPT coding is appropriately implemented, including any required changes to payer billing set up, annual CPT code changes, and test methodology changes that require changes to CPT codes.

The ICD aspect of the department includes assigning ICD codes to patient bills which ultimately affects what ICD codes are added to patient medical records through information sent to third party payors and clients.  Medical Coding maintains the implementation of yearly changes to diagnosis coding and ensures the accuracy of system updates to ICD coding on patient bills. 

The CPT/ICD coding areas are crucial functions, as they directly impact reimbursement and create enforcement risk if not handled appropriately.

This is a Remote opportunity 

Assigns CPT Coding on the test code pending listMaintains multiple systems with CPT, modifier and ICD codes, logic and changesAssists Optum360 Billing in resolving denials resulting from invalid or incorrect CPT coding and ICD codingAssists with projects related to changes in CPT codes, ICD10 codes, modifiers and laboratory system requirementsPerforms CPT Coding Audits of both standard and non-standard sites Resource for CPT/ICD questions for Optum360 coders and Quest laboratoriesApproves CPT coding requests for non-standard sites Maintains the CPT Masterfile for use by non-Standard sitesReviews quarterly National Correct Coding Initiative (NCCI) edits and annual Chapter 10 edits and determines with the Medical Coding Team what Quest tests are affectedCommunication of CPT changes to non-standard sites as necessaryEnsures proper use of NCCI edits and use of modifiersDevelops CPT, ICD, NCCI and modifier tools for use by Quest and Optum360 as neededImplements Z codes in the billing system when notified by Medical Affairs of new Z codes for Quest offeringsSupports the IR and audit teams with questions related to CPT or ICD codingSupports Franchise, Operations, Database, Billing, IT on special projects related to CPT and ICD Coding, Denials, Z codesOther duties as assigned by the Compliance Director

Required Work Experience:  

At least 3 years of experience in the clinical laboratory, or Healthcare related field. Proven ability to work in a fast-past, rapidly changing environment. 

Knowledge:

Thorough understanding of health care coverage, payment and administrative policy, and its business impact on billing, operations and financials. 

Physical and Mental Requirements:

Proven ability to work in a fast-past, rapidly changing environmentWork effectively both independently and within a teamWork in a virtual team environmentInteract professionally with colleagues within Compliance and in other departmentsPerform a variety of job duties with frequent interruptions or distractions, often changing from one task to anotherAdjust priorities quickly as circumstances dictateMaintain composure under pressureLearn and comprehend information important to the businessComprehend and follow verbal or written instructionsMake informed decisionsExamine/observe details Strong analytical skillsProblem solving and root cause identification skillsDemonstrated leadership skills including integrity, trustworthiness commitment, resilience, high energy and motivationEffective oral and written communication skills

Other:

Thorough understanding of health care coverage, payment and administrative policy, and its business impact on billing, operations and financialsDemonstrated ability to manage multiple priorities/projects simultaneouslyComplete projects while meeting goals within established time deadlinesExperience with project managementTechnical competency including Excel, Word, Outlook, Laboratory and Billing systemsUnderstanding of the technical aspects of laboratory testing

Skills:  

Excel, Word, Outlook, Laboratory or billing systems. 

EDUCATION
Bachelor’s Degree preferred

LICENSECERTIFICATIONS
AAPC Certified Professional Coder (CPC)(Required)

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets