Coding Quality Specialist 2 - Orthopedic Surgery/Musculoskeletal

About the role

Assigns and reviews the accuracy of the diagnostic codes (ICD-10-CM) and CPT codes for providers’ Evaluation and Management Services (E/M), procedures and diagnostic testing in all settings for purposes of billing, research and providing information to government and regulatory agencies.

Medical coders ensure accurate coding to support billing processes, comply with regulations, and maintain the integrity of patient health records for reimbursement and reporting purposes.

Responsibilities

• Reviews documentation in medical record to appropriately assign ICD-10-CM, CPT-4, HCPCS and modifiers within a timely manner to capture all services rendered by providers at all locations.
• Reviews and resolves charge sessions that fail charge review edits, claim edits and follow-up work queues, identifies areas of opportunity based on findings/resolution of errors.
• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture.
• Accurately deciphers charge error reasons and plans follow-up steps.
• Assists physicians/providers with questions regarding coding and documentation guidelines.
• Provides ongoing feedback based on observations from coding physician/provider documentation.
• Identifies opportunities for education and communicates trends to coding leadership and/or provider education team.
• Ensures all coded services meet appropriate governmental regulations and guidelines, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Utilizes available resources for assignment of codes as necessary (e.g., Diagnostic Imaging system, Lab system, Emergency, Epic, and coding reference software and/or books).
• Trains and provides mentorship to Coding Quality Specialist Level 1 staff to effectively perform their job responsibilities following current coding policies and procedures at the discretion of coding leadership.
• Assists coders with medical terminology, disease processes and surgical techniques.
• Assists other coders in resolving coding issues/questions.
• Performs peer review as directed from coding leadership.
• Queries physicians to obtain clarification or missing elements in the record preventing correct coding.

Requirements

• High School Diploma or GED required.
• 2+ years of relevant coding experience required.
• Certified Professional Coder (CPC) required.

Qualifications

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.

Benefits

• Comprehensive Benefits Package: Medical, Dental, and Vision Insurance.
• Paid Time Off, Long-term and Short-term Disability, Retirement Savings.
• Health Saving Plans, and Flexible Spending Accounts.
• Certification and education support.
• Generous Paid Time Off.

Pay

The pay range for this role is $23.00 - $35.32 hourly. Individual compensation will be determined by the selected candidate's qualifications, previous work experience, and/or education.