Specialty Physician Coder
Under the direction of the Coding Compliance Manager, 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 works with the Coding Compliance Manager on discovered coding trends, irregularities, and needed action items.
Job Responsibilities:
- Achievement of productivity standards as established by management.
- Achievement of 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.
- 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 and coding improvements.
- Participate in developing, implementing, and reviewing programs for coding compliance monitoring, benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
- Work in the Follow-Up and Claim Edit work queues and analyze denial trends for optimization opportunities.
- Provide ongoing and frequent communication and education to providers to maximize coding compliance and reimbursement.
- Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams.
- Work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues.
- Perform monthly coding change report analysis and oversight on provider coding change trends and communicate and educate providers as needed.
- Work weekly Missing Charge Reports to identify missed billable charges and maximize reimbursement.
- Organize, attend, and participate in specialty provider meetings.
- Prepare presentation materials for meetings.
- Document meeting minutes.
- Follow up on important action items and decisions from meetings and report to the Coding Compliance Manager.
- Take responsibility for various projects as assigned by management.
- Perform additional and miscellaneous duties as requested by the management team within the Product of knowledge and ability.
- Other duties as assigned.
Skills:
Required Skills & Experience:
- Three (3) years of experience working in a hospital or physician's office as a medical coder and interacting with physicians.
- One (1) year of experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, OR Radiation Oncology.
- Proficient in Microsoft Office suite.
- Proficient in Epic software.
- Strong analytical skills.
- Strong critical thinking skills.
- Detail oriented.
- Ability to anticipate, research, and resolve problems/problem-solving skills.
- Strong understanding of the healthcare revenue cycle.
- Excellent communication skills with the ability to communicate information accurately and clearly.
- Ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams.
- Ability to provide excellent customer service and address a moderate amount of incoming email and phone calls.
- Collaborative team player with the ability to adapt to the ever-changing healthcare environment.
- Professional demeanor at all times.
- Ability to handle complex and confidential information with discretion.
- Maintain patient confidentiality.
- Maintain a safe and orderly work area.
- Strong work ethic, honest and dependable.
- Strong personal time management skills.
- Be at work and be on time.
- Follow company policies, procedures, and directives.
- Interact in a positive and constructive manner.
- Prioritize and multitask.
- Expert knowledge of ICD-10, CPT, and HCPCS.
- Strong knowledge of medical terminology, anatomy, and physiology.
Preferred Skills & Experience:
- Epic software experience.