Coding Specialist I, PB Coding, Full-time, Days (Remote - Must reside in IL, IN, IA, or WI - Sign-on bonus eligible)

Job Description:

Job Description

The Coding Specialist I reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Coding Specialist I performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on Evaluation and Management services. This position trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function. The Coding Specialist I also demonstrates understanding and knowledge to resolve Optum coding edits.

Responsibilities:

• Utilizes technical coding expertise to review the medical record thoroughly, utilizing all available documentation to abstract and code physician professional services and diagnosis codes (inpatient admissions, bedside procedures, and/or diagnostic services).
• Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.
• Provides documentation feedback to physicians.
• Maintains coding reference information.
• Trains physicians and other staff regarding documentation, billing and coding for their specialty.
• Reviews and communicates new or revised billing and coding guidelines and information with providers and their assigned specialty.
• Attends meetings and educational roundtables, communicates pertinent information to physicians and staff.
• Resolves pre-accounts receivable edits. Identifies and reports repetitive documentation problems as well as system issues.
• Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD10 codes and modifiers. Adds MBO tracking codes as needed.
• May collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement assistance; helps identify and resolve incorrect claim issues and may assist with drafting letters in order to coordinate appeals.
• May work with Revenue Cycle staff and Account Inquiry Unit staff as requested, assists in obtaining documentation (notes, operative reports, etc.). Provides additional code and modifier information
• Meets established minimum coding productivity and quality standards for each encounter type based on type of service coded.
• May perform other duties as assigned.