Lead Coding Reimbursement Specialist - Revenue Cycle - Atrium Health Corporate FT Days

Overview

Job Summary

Performs coding duties of high complexity judgment and scope demonstrating mastery of specialty coding that enables them to provide support to physicians.

Essential Functions
 

• Subject matter expert in multiple areas of coding, e.g., surgery.
• 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.
• Codes 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.
• Reconciles processes to ensure all charges are captured.
• Automates or manually charges into applicable billing system.
• Researches and analyzes coding and payer specific issues.
• Processes charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met.
• Communicates with providers, either verbally or in writing, related to coding issues that are of high complexity. Including face to face interaction, explaining coding rationales, and education with providers.
• Coaches providers on documentation improvement.
• Develops and mentors teammates of the same or similar specialty and serve as an internal resource.
• Conducts quality assurance reviews for a designated specialty to determine additional training opportunities.
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Physical Requirements
Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending. 

Education, Experience and Qualifications
High School Diploma or GED required. 5 years of coding experience required. CPC or equivalent coding credential required. Maintains coding certification (CPC, CCS, RHIT, RHIA). Extensive knowledge of coding, medical terminology, anatomy, and physiology. Extensive knowledge of and the ability to apply the payor 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.