Coding Reimbursement Specialist II

Requirements

• Performs initial charge review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers.
• Interprets progress notes, operative reports, discharge summaries, and charge documents to determine services provided and accurately assign CPT and ICD-10 coding to these services, according to guidelines established by the AMA.
• Enter appropriate data into the TMP billing system by selecting the appropriate codes, diagnosis, modifiers, to complete the charge process.
• Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met.
• Contact physicians through query protocols regarding procedures and other services billed to ensure proper coding.
• Responsible for reviewing patient logs and other reports of clinical activity to ensure billing is captured for all patients.
• Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.
• Works in conjunction with the Reimbursement staff to answer all inquiries regarding coding and billing for TMP physicians' services.

Requirements

• A high school diploma or GED completion is required.
• A minimum of three (3) years’ experience with CPT and ICD-10 coding of physician services is required.
• Coding certification is required. CPC Certification is preferred. Must maintain active certification and required CEUs during employment tenure.
• Advanced working knowledge of medical terminology, anatomy, and physiology is required.
• Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers is required.
• Understanding of and familiarity with regulatory guidelines including NCDs and LCDs is required.

Experience

• Family Practice, Internal Medicine, Cardiology, Rheumatology, Endocrinology, Gynecology, and Dermatology are preferred.
• Knowledge of current third-party billing and collection regulatory guidelines and requirements is required.
• Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions is required.
• Advanced knowledge of, but not limited to, Official Coding Guidelines and methodologies is required.
• Good interpersonal skills and a basic understanding of team concept is required.
• Ability to gather and interpret clinical data is required.
• Ability to work independently in a fast-paced environment is required.

Physical Requirements

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details is required.
• Use of computer for long periods of time is required.