Coding Specialist, MIT Medical
Reports to: Coding Supervisor
The Coding Specialist evaluates medical record documentation and coding to ensure that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines. Provides technical guidance to clinical providers and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines. Interprets a wide variety of clinical and diagnostic documentation, including complex medical cases and treatments to identify diagnoses, complications, comorbidities, and procedures associated with outpatient visits. Assigns current set of diagnosis, CPT, HCPC and modifier codes as appropriate, adhering to official coding guidelines.
The Coding Specialist will also review all medical necessity denials received from payers and review medical records to determine if resubmission is appropriate. The Coding Specialist will educate clinical staff on coding, documentation issues, as well as federal regulatory guidelines and compliance. The Coding Specialist will also prepare slides or documents for use in coding and clinical training documentation. The Coding Specialist will be an independent resource for CMS compliance changes, CC, NCD and LCD regulations.
Principal Duties and Responsibilities:
- Review and correct charges submitted by clinical providers on patient encounters prior to claims filing and upon denials. Tie diagnosis codes (ICD-10), procedure codes, HCPCS codes and modifiers, as needed.
- Re-work and update encounters for electronic charge submission.
- Follow up on denials through Cerner through communication with clinical providers and billing staff members. Utilize this information for coding education and resubmissions of claims.
- Monitor coding related reports on a weekly basis primarily to use for reporting and provider training.
- Participation in a CDI (Clinical Documentation Improvement) program audit system. Report findings and needs for improvement to clinical providers.
- Identifies training needs, prepares training materials, and conducts training for clinical providers and support staff to improve skills in the collection and coding of quality health data.
- Create trainings based on several factors such as need, QA findings, trends, clinician request, and compliance regulation changes.
- Respond to clinical provider inquiries in a speedy and professional manner.
- Support clinical providers with understanding compliance and documentation.
- Research appropriate codes for clinical providers, if requested, and provide necessary and accompanying documentation.
- Work with clinical providers updating any appropriate coding inquiries for the EMR.
- Work with IT to support the clinical providers’ effective use of the EMR by researching and providing feedback based on reports, claims submissions and denials.
- Provide assistance and guidance to junior coders and billers on coding and documentation issues.
- Actively participate in team meetings in order to understand where efficiency can be improved; work on solutions to optimize quality, efficiency and productivity.
- Keeps up to date on insurance filing regulations through websites of insurance carriers and outside sources.
- Relays information on new regulations to team from newsletters and/or attendance at coding seminars.
- Attends seminars and maintain certification and CEU’s.
- Seeks to learn new skills and integrates them into daily work.
- Recognizes problems, reports them, and works toward solutions.
- Assists Coding Supervisor with special projects and helps with guiding coding team members and or new coding initiatives.
Minimum Required Education and Experience:
- Must hold current coding certification, either CPC, RMC, CCS, CCS-P and/or RHIT.
- Ability to read and interpret medical procedures and terminology.
- Must be familiar with Medicare billing and compliance policies (Federal mandates) as well as other third-party payers.
- Minimum of five years of relevant experience in coding. In depth knowledge of anatomy & physiology and medical terminology.
- Must demonstrate superior judgment, analytical thinking and organizational skills.
- Must exhibit effective written and verbal communication and interpersonal skills for interaction within a diverse community.
- Ability to develop training materials, make group presentations, and to train staff
- Must be self-motivated and able to work independently.
- Must be able to process data accurately and efficiently, take initiative, set priorities, and have confidence in decision-making.
- Knowledge of federal/state privacy guidelines e.g. HIPAA
- Ability to prioritize workload and adjust if needed; ability to multi task effectively.
- Cerner application knowledge preferred. Comparable EMR/practice management system knowledge acceptable.
- Must be proficient in Microsoft PowerPoint or an equivalent presentation program. Also, should have strong knowledge of Microsoft Excel.
- College degree strongly desired.