Specialty Physician Coder, OBGYN

About the role

Under the direction of the Coding Compliance Supervisor, the Specialty Physician Coder plays a key role in reviewing and analyzing specialty coding and billing for charge processing. This role is responsible for reviewing and accurately coding office, hospital, and surgical/procedures for reimbursement and ensuring accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients. The Specialty Physician Coder will also work with the Coding Compliance Manager on discovered coding trends and irregularities and needed action items.

Responsibilities

• Achieve productivity standards as established by management.
• Achieve quality standards as established by management.
• Analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines, including the ability to review and natively code surgical operative and/or procedure reports.
• Follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements.
• Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
• Provide ongoing and frequent communication/education to MCMF providers to maximize coding compliance and reimbursement.
• Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams and work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues.
• Perform monthly coding change report analysis/oversight on provider coding change trends and communicate/educate the providers, as needed.
• Work weekly Missing Charge Reports to identify missed billable charges to maximize reimbursement.
• Organize, attend, and participate in specialty provider meetings. Prepare presentation materials for meetings, document meeting minutes, follow up on important action items/decisions from meetings, and report to the Coding Compliance Manager.
• Take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.

Requirements

• 3 years’ experience working in a hospital or physician’s office as a medical coder and interacting with physicians.
• 1 year’s experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, or Radiation Oncology.
• Expert knowledge of ICD-10-CM, CPT, and HCPCS.
• Strong knowledge of medical terminology, anatomy and physiology.
• Epic software experience is highly desired.
• Proficient Microsoft skills.

Qualifications

• CPC, CCS, or equivalent certification required.
• COBGC specialty coding certification is highly desired.