GENERAL SUMMARY/ OVERVIEW STATEMENT:
The Coding Specialist II reports to the Coding Supervisor and is accountable for correct coding of professional services and maintaining compliance standards.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
The Coding Professional II is needed to:
§ Perform complex coding and related tasks utilizing established Professional Billing Office and Coding Services policies in an accurate and prompt way. Review complex and distinct medical documents and system produced charges or paper encounter kinds. Appropriately designate CPT ®, ICD-9, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements.
§ Ability to research complex billing guidelines and regulations for new and existing procedures
§ Show a commitment to integrating coding compliance requirements into day-to-day coding practices. Identify, fix and report coding issues.
§ Maintain present understanding of coding, compliance and reimbursement procedures. Evaluation current literature, newsletters, payor policy updates and coding manuals.
§ Resolve complex coding edits and rejections in a timely way. Determine chances to minimize denials and boost income.
§ Capability to provide cross protection of several complex specialties
§ Function as a resource to Expert Billing Office personnel and external consumers. Research study and deal with coding inquiries. Make recommendations for coding policy modifications. Take part in the electronic or paper encounter form revision process to ensure appropriate coding requirements are satisfied.
§ Performs quality control evaluations of all Coding Professionals in locations of expertise.
§ Functions as subject professional for assigned specialties
§ Establish and maintain department particular coding procedures.
§ Total unique jobs as designated by management which need defining issues, identifying work series, summarizing findings, and carrying out needed changes.
§ Participate in coding education for companies and co-workers.
§ Maintain coding certification.
Qualifications
CERTIFICATIONS:
§ Conclusion of a Coding Certificate program or Health Infotech Program or work experience comparable needed.
§ High school diploma required
§ Course work in anatomy and physiology, medical terms highly chosen.
§ A Minimum of 2 years of experience in coding required.
§ Coding Accreditation from American Academy of Specialist Coders (AAPC) or American Health Info Management Association (AHIMA) is needed. Accreditation may consist of CPC ®, CPC-H, CCS, CCS-P.
§ Advanced Specialty or extra associated certifications preferred however not needed.
ABILITIES/ CAPABILITIES/ COMPETENCIES REQUIRED:
- Advanced Efficiency in ICD-9, ICD-10, CPT ®, HCPCS, and modifiers for coding of expert fee services.
- Advanced knowledge of anatomy and physiology, medical terminology and insurance coverage compensation policies and guidelines.
- Excellent composed and spoken communication abilities and the capability to focus on and arrange work to satisfy stringent due dates are required.
- Precision and attention to information
- Competent with computer system applications (MS Workplace etc), good information entry skills
WORKING CONDITIONS:
The Professional Billing Workplace lies in the Charlestown Navy Backyard school.
Mass General Brigham.
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