Coding Specialist II

About the role

The Coding Specialist is responsible for the review and resolution of all coding related prebilling edits and/or rejections to ensure prompt and accurate reimbursement. The individual will report to the Operation Billing Manager at the Department of Surgery. This position initiates medical record review and recommends proper action. This position communicates with department clinical and billing staff regarding missing or unclear documentation.

Responsibilities

• Review and resolve all assigned tasks/encounters associated with coding discrepancies as it relates to prebilling system edits and/or claims with outstanding balances.
• Reduces accounts receivable by reviewing claims rejected for coding.
• Investigates assigned accounts to determine what additional steps must be taken for claims to be resolved.
• Provide guidance and suggestions to clinical departments for prebilling coding edits.
• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the hospital.
• Review and follow up on denials related to coding and charge entry processes; if a claim is denied due to incorrect coding, conducts medical records research and corresponds with insurance companies and clinicians to resolve issue.
• Manages appeals with insurance companies for surgical claim reimbursement when appropriate.
• Assess clinical documentation supporting services.
• Researches and responds to insurance coding requests.
• Assists with claim issues, including preparing coding appeals.
• Serves as liaison between clinicians, billing consultants, patient financial counselor and insurance carriers to discuss coding issues.
• Maintain tracking reports when issues and trends have been identified.
• Support other functions as assigned.

Requirements

• Bachelor's degree or equivalent in education and experience
• 3 years of related experience
• Certified Professional Coder (CPC)
• Knowledge of CPT and ICD-IO coding
• Intermediate MS Office Skills
• Strong written and verbal communication skills
• Working knowledge of contracts, insurance billing requirements, payers, Medicare and Medicaid
• Ability to follow through and handle multiple tasks simultaneously
• Proven to exceed standard productivity levels
• Proven attendance and punctuality record
• Work requires manual dexterity for handling charts and using office equipment - specifically the use of a computer keyboard and calculator
• Must be able to stoop and bend to retrieve files and supplies, and sit, stand or move around for extended periods of time

Pay

Salary Range: $68,000.00 - $75,000.00. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.

Schedule

Hours Per Week: 35. Standard Work Schedule: Mon - Fri (9am - 5pm).