JOB TITLE: Coding Specialist
REPORTS TO: Revenue Cycle Manager
FLSA STATUS: Non-Exempt
JOB SUMMARY:
In-depth knowledge of Procedural Coding, Specialist in identifying appropriate ICD10 coding based on CMS/HCC categories, analyzes medical records and identifies documentation deficiencies, CPT, HCPCS CMS 1500 FORM, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB, Payments.
QUALIFICATIONS/EDUCATION:
CERTIFICATIONS/LICENSES:
ABILITIES/SKILLS:
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In depth knowledge of CPT, ICD10 and HCPCS coding.
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Excellent communication, Customer Service and telephone skills.
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Strong organizational skills and ability to multi-task effectively.
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Must be able to work independently with minimal supervision.
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Able to respect and maintain patient confidentiality at all times. Functions with minimal direct supervision.
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Must be dependable and conduct him/herself in a professional manner.
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Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
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Must be able to follow policies and procedures.
SUPERVISORY RESPONSIBILITIES:
N/A
ESSENTIAL DUTIES/ RESPONSIBILITIES:
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Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
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Researches and analyzes coding data to maximize reimbursement.
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Process claims daily, check for errors, making sure that correct diagnosis and CPT codes are used.
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Review claims and determine if Auth or Referral is needed, process accordingly.
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Maintain the billing process within a 15 - day timeframe.
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Must be able to process between 80 to 100 claims per day and submit batch to clearinghouse daily.
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Review progress notes and operative reports before submitting claim.
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Review patient information to determine or identify claim denial causes.
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Submit weekly billing report to manager.
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Maintain accurate and detailed chart notes in the system.
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Perform any other duties as assigned.
