Coding Specialist II - Clinical Practice Services

Primary Responsibilities

• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.
• Charge Entry as needed.
• Reconciliation Of Charges
• Maintain oversight of charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow.
• Work with clinic staff and physicians regarding missing or unclear information that is required for billing.
• Claim Denials / Billing Issues
• Identify, report, and resolve coding and reimbursement issues. Work with physicians, department administrators and other billing office staff, including reimbursement staff. Identify opportunities to reduce denials and enhance revenue.
• Protocols
• Develop and maintain all protocols related to their assigned areas.
• Provider Education
• Maintain understanding all Teaching Physician and provider documentation policies. Actively participate in new provider orientations. Note and address trends in provider documentation that may impact coding and billing.

Qualifications

• Appropriate experience may be substituted for education on an equivalent basis.
• Minimum Required Education: High school diploma
• Minimum Required Experience: 2 years of related coding and/or health care experience
• Preferred Experience: Office experience
• Required Certification/Licensure(s): Coding certification (CPC, CPC-A, CCS-P, or CCA) and/or Health Information Management credential (RHIT or RHIA).

Physical Requirements

• Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids.
• Work is performed in an environmentally controlled environment.
• Sensory Acuity Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.