Coding Reimbursement Specialist III - Revenue Cycle

Overview

Job Summary

Performs duties of moderate to high complexity, analyzes denial data, reports and work queues to depict trends and offer solutions.

Essential Functions

• Subject matter expert in at least one specialty, e.g., oncology, gynecology, surgical coding (not including primary care procedures) and infusion coding including chemotherapy and infusions involving multiple drugs.
• Assigns CPT and ICD codes in cases of moderate to high complexity.
• Reads, interprets and assigns CPT codes from provider documentation, e.g., infusion record or 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.
• Processes charges on a timely basis and communicates with team members and practice management on an ongoing basis.
• Communicates with providers related to coding issues that are of moderate to high complexity. Including face to face interaction, explaining coding rationales, and education with providers.

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 2 years of coding experience required. CPC or equivalent coding credential required. 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.