Major Responsibilities:

In collaboration with Customer Service, analyze and resolve professional coding complaints in a timely manner using correct coding and payer guidelines to ensure patient satisfaction.Identifies and analyzes coding denials for a specific population of charges and works in collaboration with the Production Coding team. 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. Develops standardized processes and tools for the coding production team to utilize when dealing with insurance rejections and recommendations to avoid future denials.Works with Professional Coding Leadership to develop monthly coding update reports to continually educate and communicate coding related recommendations based on monthly findings. Maintains up-to-date information regarding coding denials 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, identified trends, and recommendations to prevent future coding rejections/denials.Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally (i.e., NCD, LCD) accepted coding policies and standards. Develops expertise in coding for assigned specialties. Communicates and reinforces changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinates necessary modifications and updates appropriately.Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding based on CPT, ICD-10 CM/PCS, HCPCS in accordance with coding and payer guidelines.

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 5 years of professional coding and at least 3 years of payer background experience in physician revenue cycle processes, health information workflows and reimbursement in a large, complex clinic or medical group.

Knowledge, Skills & Abilities Required:

Advanced knowledge of ICD, CPT and HCPCS coding guidelines.Advanced of medical terminology, anatomy, and physiology.Advanced ability to identify coding discrepancies and provide recommendations for improvementAdvanced ability to analyze trends and data and display them in a statistical reporting format.Advanced knowledge of care delivery documentation systems and related medical record documents. Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.Advanced 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.Excellent organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.Excellent 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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