Coding Escalation Specialist- Pro Fee Hospital
Job Summary
The Medical Coding Escalation Specialist is responsible for handling complex coding issues, resolving coding-related escalations, and providing expert-level support to the medical coding team. This role involves conducting thorough reviews of medical records, ensuring accurate code assignment, and serving as a liaison between coders, auditors, providers, and compliance teams. The specialist ensures coding practices adhere to regulatory requirements, payer policies, and internal standards.
Essential Functions And Tasks
- Review and resolve escalated coding issues from coders, auditors, billing teams, and providers.
- Analyze medical records and documentation to ensure accurate and compliant code assignment.
- Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules.
- Identify coding trends, discrepancies, and compliance risks; recommend corrective actions.
- Participate in coding audits and assist in implementing audit recommendations.
- Educate and mentor coding staff on complex cases and updates to coding regulations.
- Ensure adherence to all applicable coding standards (CMS, AHA Coding Clinic, AMA CPT Assistant).
- Support continuous improvement initiatives in coding accuracy, workflow, and documentation quality.
- Maintain up-to-date knowledge of coding updates, regulatory changes, and payer guidelines.
Education And Experience Requirements
- Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance.
- AAPC or AHIMA certification required.
Knowledge, Skills, And Abilities
- Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
- Strong understanding of CMS regulations and payer-specific guidelines.
- Excellent analytical, problem-solving, and decision-making skills.
- Effective communication and interpersonal skills.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Experience with electronic health records (EHRs) and coding software systems.
- Ability to read, understand, and apply state/federal laws, regulations, and policies.
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
- Ability to remain flexible and work within a collaborative and fast-paced environment.
- Basic use of computer, telephone, internet, copier, fax, and scanner.
- Basic touch 10 key skills.
- Basic Math skills.
- Understand and comply with company policies and procedures.
- Strong oral, written, and interpersonal communication skills.
- Strong time management and organizational skills.
- Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
Compensation
Base compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies.
Benefits
Commensurate with experience.
Pay
TBD
Schedule
TBD
Qualifications
Commensurate with experience.
Skills
Commensurate with experience.
Benefits
Commensurate with experience.
Pay
TBD
Schedule
TBD
Contact Information
Careers@VentraHealth.com