Major Responsibilities:

Identifies and analyzes professional coding complaints, denials and appeals for a specific population of charges. Working in collaboration with production coders.Coordinates coding rejection data collection activities used for reporting and accountability tracking. Identifies potential trends or knowledge concerns and opportunities for improvement and prevention.Researches and documents applicable regulatory, coding and billing rules and provides education materials for the department educators and coding liaisons. Develops standardized processes, letters and mechanisms for the coding production team to utilize when dealing with insurance rejections.Works with revenue cycle leadership, clinic operations managers, finance, coding and compliance staff to review regulatory changes. Maintains up to date information in regards to coding appeals and rejections and communicates the changes accordingly.Identifies and problem solves trends and issues. Collaborates with department leadership clinic operations managers, system contracting team to determine preventative measures, follow-up and resolve these issues. Communicates with and acts as a resource for others regarding coding and appeal issues.Provides regular statistical reports to leadership regarding rejection/denial volumes, response timeliness, success rates, trends identified and corrective actions taken to prevent future repeats.Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), orCoding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), orHealth Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), orHealth Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), orProfessional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), orSpecialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC).

Education Required:

Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

Typically requires 2 years of experience in professional coding that includes experiences in physician revenue cycle processes, health information workflows and reimbursement in a large, complex clinic or medical group.

Knowledge, Skills & Abilities Required:

Intermediate knowledge of ICD, CPT and HCPCS coding guidelines.Intermediate knowledge of medical terminology, anatomy and physiology.Intermediate knowledge of care delivery documentation systems and related medical record documents.Advanced knowledge of Medicare, Medicaid and commercial payer coding guidelines.Intermediate computer skills including the use of Microsoft Office, email and exposure or experience with electronic coding systems or applications.Proficient interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.Intermediate organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.Intermediate analytical skills, with a great attention to detail.Ability to work independently and exercise independent judgment and decision making.Ability to meet deadlines while working in a fast-paced environment.

Physical Requirements and Working Conditions:

Exposed to normal office environment.Position requires travel which will result in exposure to road and weather hazards.Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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