Coding Specialist III

Responsibilities

• Review and resolve all assigned tasks/encounters associated with coding discrepancies as it relates to pre-billing 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 pre-billing 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.
• Manage appeals with insurance companies for surgical claim reimbursement when appropriate.
• Assess clinical documentation supporting services.
• Oversee insurance coding requests.
• Affix claim issues, including preparing coding appeals.
• Serve as liaison between clinicians, billing consultants, patient financial counselors, and insurance carriers to discuss coding issues.
• Create new edits related to payors and CMS guidelines to release to clearing house.
• Train new coders and billers.
• Support other functions as assigned.

Qualifications

• Bachelor's degree or equivalent in education and experience.
• Three years of related experience.
• Certified Professional Coder (CPC), preferred.
• Intermediate MS Office skills.

Requirements

• Transplant Coding Knowledge.
• Knowledge of CPT and ICD-10 coding.
• 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.