Coding Specialist Senior

About the role

The Senior Coding Specialist performs coding tasks to promote efficient operation of the physician practices within Chesapeake Regional Medical Group.

Responsibilities

• Obtain pathology and operative reports from hospital systems.
• Assign and sequence ICD diagnostic, procedural, and CPT codes to ASC records.
• Identify all complicating conditions/co-morbidities to ensure optimum reimbursement.
• Maintain established productivity requirements.
• Accurately enter various code and charge information into information systems.
• Review appropriate reports for validation of accurate transmission.
• Resolve transmission errors and resubmit claims.
• Report all payments on collection claims to the Collections Specialist(s).
• Attend required hospital-wide orientations, meetings, and in-services.
• Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care.
• Complete all assigned charge entry, coding, billing, and follow-up in a timely manner.
• Manage HOLD Bucket/worklist; assist and train Billing Representatives for all practices, departments, and locations.
• Provide back-up phone coverage for all practices, departments, and locations, including patient statement calls and CRMG, CRNI, and SAS staff support.
• Process refunds and train staff on refunds for all practices, departments, and locations.
• Manage AIR Aging Wizard activities for all practices, departments, and locations.
• Conduct internal audits for all practices, departments, and locations.
• Support new practice go-live implementations.
• Demonstrate comprehension of payer guidelines for appeals, overpayments, retractions, refunds, eligibility, reconsiderations, referrals, authorizations, payer websites, filing limitations, denials, and attachment requirements to work all claims to a zero balance in a timely manner.
• Retrieve clinical or financial documents from other scanning programs (e.g., OnBase).
• Handle Release of Information requests.
• Participate in and attend approved healthcare/insurance webinars and seminars.
• Maintain up-to-date working knowledge of assigned payors, LCD/NCO, CPT, and ICD-9/ICD-10.
• Attend and participate in monthly billing meetings.
• Report to manager on a weekly or monthly basis regarding scheduled and assigned tasks/projects.
• Create cases for coding team members for any claims in assigned worklists that pertain to coding issues.
• Provide front desk support following go-live implementation of new electronic medical records.
• Possess the ability to fill in as a Patient Service Representative as directed by the manager.

Qualifications

• High School Diploma (required).
• Courses in Medical Terminology and Ancillary Testing (preferred).
• One or more years of hospital and/or medical office experience.
• Typing speed of 35+ words per minute.
• Proficient knowledge of computer functions and operations.
• Current Certified Professional Coder (CPC) certification or obtain CPC certification within one year of hire date.

Reports to: Practice Office Manager