Medical Billing & Coding Specialist

Essential Functions

• Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere
• Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits
• Complies with all medical coding guidelines and monitors evolving regulatory and industry changes
• Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings
• Follows up and clarifies any information that is not clear with the rendering provider
• Collaborates with IT and EHR teams to improve charge automation and optimize workflows
• Conducts ad-hoc audits to ensure fidelity to coding guidelines
• Relevant expert for Southwest Network on accurate and efficient coding practices
• Analyze medical records and identify documentation deficiencies

Nonessential Functions

• Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program
• Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical and professional guidelines adopted by Southwest Network
• Other duties as assigned