Senior Coding - Reimbursement Specialist - Revenue Cycle

Job Summary

Performs coding duties of high complexity, judgment, and scope. Independently able to interpret and analyze documentation and assign all relevant coding rationale.

Essential Functions

• Subject matter expert in multiple areas of coding, e.g., surgical coding (not including primary care procedures).
• Assigns CPT and ICD codes in cases of high complexity, judgment and scope.
• Reads, interprets and assigns CPT codes from provider documentation, e.g., operative report.
• Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered.
• Appends all modifiers.
• Ranks CPT codes when multiple codes apply.
• Assigns Evaluation and Management (E/M) codes.
• Performs reconciliation process to ensure all charges are captured.
• Processes automated or manually enters charges into applicable billing system.
• Researches and analyzes coding and payer specific issues.
• Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met.
• Mentors teammates and coach providers on documentation improvement.

Physical Requirements

Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending.

Education, Experience and Certifications

High School Diploma or GED required. Minimum of five years of coding experience required. CPC or equivalent coding credential required. Effectively communicates, either verbally or in writing, with providers related to coding issues that are of high complexity. Including face to face interaction, explaining coding rationales, and education with providers. Maintain coding certification (CPC, CCS, RHIT, RHIA). Extensive knowledge of coding, medical terminology, anatomy, and physiology. Extensive knowledge of and the ability to apply the payer specific rules regarding coding, bundling, and adding appropriate modifiers. In depth knowledge of claim editing rationale and revenue cycle. Basic knowledge of Relative Value Units. Understanding of and familiarity with regulatory guidelines including NCDs and LCDs. Excellent written and verbal communication skills.