Coding Specialist (Full-time, Days - Fully Remote)

About the role

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Responsibilities

• Review, promote, and evaluate professional coding and professional fee billing for Penn Medicine Lancaster General Health Physicians (LGHP).
• Serve as a first point of contact for coding inquiries and act as a resource to practices for coding issues and education.
• Optimize revenue through appropriate coding while adhering to official coding guidelines to ensure accuracy and compliance when billing insurance carriers.
• Perform annual chart reviews of professional fee billing for LGHP and certain LGH Practices.
• Ensure accurate and appropriate gathering of information into coding classification systems to meet departmental, hospital, and outside agency requirements.
• Obtain accurate and complete documentation in the medical record for accurate coding assignment, severity of illness, and risk of mortality for each medical record.
• Interact with physician and non-physician providers to maximize correct coding initiatives.
• Analyze and resolve issues of missing charges and problem accounts by researching information regarding department reimbursement.
• Perform systematic reviews of professional fee billing and coding for non-governmental carriers using an established point system ensuring that documentation supports billed services.
• Educate providers from research and audit findings as needed.
• Compile and prepare materials for meetings as necessary; ensure accuracy of information provided.
• Prepare and present coding education to new providers joining the practices to ensure understanding of current evaluation and management guidelines.
• Identify patterns in denials and work with appropriate parties to correct errors and mitigate future errors.
• Research topics with the capability to interpret complex rules and regulations.
• Keep abreast of CPT coding changes.
• Assure that quality and timely coding, charging, and abstraction of accounts are completed daily for assigned specialty areas.
• Contact physicians or any persons necessary to obtain information required to accurately code assignments.
• Work and communicate with other offices in any manner necessary to facilitate the billing process.
• Monitor on an ongoing basis provider documentation.
• Perform audits to assess provider coding accuracy and follow up with provider education as needed.
• Provide assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.
• Review and resolve charges in work queues based on payer edits, CCI edits, and coding-related denials.
• Collaborate with customer service department to resolve coding-related patient complaints.
• Monitor payer guidelines to ensure accurate coding, including local Medicare Administrative Contractor guidance, state payer rules, regulations, and trade publications.
• Assist the team with occasional special projects.
• Perform duties in accordance with Penn Medicine and entity values, policies, and procedures.

Requirements

• High School Diploma (required).
• Two years of practical coding experience.

Qualifications

• Formal education in ICD-10-CM coding, CPT-4 coding, and medical terminology.
• Certification in one of the following: RHIT, RHIA, CCS, COC-A, COC, CIC.
• Graduate of Health Information Technology (HIT) or equivalent program OR Medical Coding Certification Program.
• One year of experience with Epic.
• Three to five years of experience with physician billing.
• One year of medical coding experience strongly preferred.

Licenses, Registrations, and Certifications

• Certification as Certified Coding Specialist for Physicians (CCS-P) or a Certified Professional Coder (CPC).
• If not certified, coding certification is required within three years of employment.