Medical Coding Specialist III

Responsible for coding from medical records to identify revenue opportunities and to ensure documentation compliance. Works closely with departments to optimize reimbursement, ensure charge capture, reduce late charges and provide feedback to providers.

JOB FUNCTIONS:

•  Abstracts diagnosis codes, minor surgical procedures, endoscopies, diagnostic procedures and major surgical cases from medical records.
•  Applies CPT-4, ICD-10-CM, HCPCS and modifiers following coding standard guidelines.
•  Understands current regulatory coding requirements, which include Federal, State and local guidelines.
•  Improves cash flow due to filing of “clean” claims by utilizing correct coding practices.
•  Provides feedback to physicians related to revenue opportunities.
•  Ensures all services are accounted for and billed.
•  Involves working closely with physicians.
•  Keeps abreast of research projects within the department.

Education:

• High School Diploma or equivalent.

Experience:

• Three to five years of ICD-10-CM, CPT-4, HCPCS, insurance billing and reimbursement, surgical abstracting

Certification:

• CPC certification equivalent; specialty certification preferred.

PERFORMANCE REQUIREMENTS:

Knowledge, Skills and Abilities:

• Strong understanding of current regulatory coding requirements, reimbursement and billing process of services rendered in a teaching facility, medical office, hospital or Skilled Nursing Facility.
• Excellent written and verbal communication skills.
• Excellent attention to detail.
• Ability to identify problems and find creative and effective solutions.
• Ability to research and follow up on issues.
• Proficiency testing for baseline assessment.

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position in a well lighted office environment. Frequent contact with a variety of people.

Physical Requirements:

• Involves sitting approximately 80 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 25 pounds.

Safety:

• All employees are responsible for complying with safe and healthful work practices as outlined in Inspire Health’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.