Orthopedic Surgery Coding Specialist (Remote)

Description

Shift: Monday - Friday / 8:00 am to 5:00 pm MST

Job Summary:

 Orthopedic Coding Specialist is responsible for maintaining current and high-quality ICD-10-CM, CPT and HCPCS coding for the E/M, Radiology, Physical Therapy, DME, and Orthopedic procedures, through the review of clinical documentation and diagnostic results, with a consistent coding accuracy rate of 95% or better. Orthopedic Coding Specialist will accurately abstract data from any and all appropriate electronic medical record systems, verifying accurate patient dispositions and physician data, following the Official ICD-10-CM, CPT and HCPCS for Coding and Reporting and AMA CPT Guidelines and enter data, accurately, into our PM system. Coder will work collaboratively with various departments, including but not limited to the Medical Records, and Reimbursement Specialists, to ensure accurate and complete physician documentation to support accurate billing and reduce denials. Coder will also assist in other areas of the department, as requested by leadership. Coder will report directly to the Revenue Cycle Manager, with additional leadership from the Director of Revenue Cycle. 

Essential Duties & Responsibilities:

Code Master Files

• Assist lead coder in maintaining procedure and diagnoses code master files.

Distribute Coding Information

• Distribute coding information to appropriate personnel.

Coding Issue Resolution

• Work with medical staff to resolve coding issues and associated problems.

Patient Charge Resolution

• Resolve patient charge concerns or issues.

Patient Charts

• Review patient charts for clinical information to aid with coding issues.

Post Clinical Charges

• Post all clinical and physical therapy CPT codes and charges to patient's correct account and prepare account for submission to patient's insurance provider by insurance/patient representative.

Denial Follow-up

• Follow-up on denials and/or rejections; assist insurance/patient representative with office and physical therapy coding issues.

Assign Accurate Codes

• Assign accurate CPT, ICD-10, HCPCS and modifiers to report services that were performed and provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance company.

Understanding E&M

• Understanding of Evaluation and Management (both the 1995 and 1997 Documentation Guidelines).

Medical Necessity

• Understanding of medical necessity, claim denials, bundling issues, and charge capture.

Integrate Changes

• Integrate medical coding and reimbursement rule changes into the practice's reimbursement process.

RVU's

• Understanding of RVU's and how to calculate fees.

Coding Practices

• Foster an environment that supports honest and ethical coding practices resulting in accurate and reliable data.

Caretracker

• Assign accurate CPT, ICD-10, HCPCS, and modifiers to
• services/procedures that were performed.
• Correctly enter the data into Caretracker.
• Use correct revenue codes, date of injury, referring provider, admission/discharge dates, etc.
• This will include operative reports, surgery worksheets, clinic visits, and physical therapy visits.

Missing Encounters

• Review missing encounters reports daily to ensure there are not any missing items over two (2) days old.

Claims Worklist

• Review Caretracker's Claims Worklist and correct any claim or payor edits.

Other Duties

• Performs other duties as directed/required to ensure efficient operations of Premier Bone & Joint Centers.

Policies, Procedures and Reimbursement Knowledge

• Knowledge of coding policies and procedures and reimbursement practices.

Reimbursement Regulations

• Maintain current knowledge of reimbursement regulations.

Health Insurance Knowledge

• Knowledge of health insurance processing and clinic operating policies.

Medicare Knowledge

• Knowledge of Medicare and Medicaid, as well as Worker's Compensation, billing policies and procedures.

Life Cycle

• Knowledge of the life cycle of a medical billing claim and how to improve the revenue cycle.