Medical Coding Specialist

US-AZ-Phoenix
Job ID
2017-2640
# Positions
2

Overview

Under the direction of the Director of Contracts and Medical Coding, the Medical Coding Specialist will perform data quality reviews of medical records for compliance with federal coding regulation and guidelines. Uses knowledge of coding guidelines to provide a second level review of all Codes (CPT, E/M, ICD-10, etc.) to achieve and maintain compatibility with regulatory and payer billing requirements and compliance standards. This position collaborates with Chief Medical Officer to provide training and education to Coding and Medical staff. This position reviews and resolves coding issues related to billing and coding/documentation and participates in process improvements related to coding and E/M management.

Responsibilities

  • Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments and provide feedback to the healthcare professional and management; checks for missed secondary diagnoses; ensures compliance with all outpatient reporting requirements; monitors medical visit code selection against agency specific criteria for appropriateness; assists in the development of such criteria as needed.
  • Performs claim denial reviews on outpatient encounters to validate the International Classification of Diseases Manual (ICD-10-CM) and provide feedback to the healthcare professional and management.
  • Communicates and trains healthcare professionals and others in the use of technical coding guidelines and practices and proper documentation techniques to maximize accuracy, completeness, and compliance with acceptable standards of practice and coding guidelines.
  • Reviews encounters, when requested by Claims Department and other departments to research and resolve coding issues related to billing.
  • Maintains knowledge of current industry coding and compliance issues; Maintains required coding certification.

Qualifications

  • Certificate or Associate’s Degree in medical coding or related field.
  • Certified Professional Coder (CPC) certification required.
  • One year of Physician E/M Auditing experience.
  • Two years of Ambulatory Medical Record Coding experience, abstract preferred.
  • Comprehensive knowledge of ICD-10-CM, CPT, HCPCS Level II coding and the current Diagnostic and Statistical Manual of Mental Disorders (e.g., DSM V).
  • Staff training experience in a healthcare setting.
  • Previous experience interacting with external coding auditors.
  • Advanced principles and practices of medical record keeping; advanced medical terminology, anatomy and physiology, as well as the states, sequence, progression and description of diseases as they apply to medical record coding.
  • Knowledge of appropriate methods for auditing and reviewing information for quality control purposes.
  • Ability to understand and apply anatomical, physiological and medical terminology.
  • Ability to conduct chart reviews using the 1997 E&M Guidelines.
  • Ability to conduct chart reviews of outpatient medical records to verify the appropriateness of diagnostic codes selection and medical record abstracts.
  • Ability to work with physicians and others to ensure complete and accurate information and optimal reimbursement based on coding and abstracting of medical records.
  • Ability to communicate clearly and concisely, both verbally and in writing.
  • Ability to exercise discretion and independent judgement with respect to matters of significance.

 

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