Physician Coding AR Specialist - Medical Specialties

Overview

Physician Coding AR Specialist - Medical Specialties

• In collaboration with Customer Service, analyze and resolve professional coding complaints in a timely manner using correct coding and payer guidelines to ensure patient satisfaction.
• Identify and analyze coding denials for a specific population of charges and work with the Production Coding team. Coordinate coding rejection data collection used for reporting and accountability tracking. Identify potential trends or knowledge concerns and opportunities for improvement and prevention.
• Research and document applicable regulatory, coding and billing rules. Develop standardized processes and tools for the coding production team to use when dealing with insurance rejections and recommendations to avoid future denials.
• Collaborate with Professional Coding Leadership to develop monthly coding update reports to educate and communicate coding-related recommendations based on monthly findings. Maintain up-to-date information regarding coding denials and rejections and communicate changes accordingly.
• Identify and problem-solve trends and issues. Collaborate with department leadership, clinic operations managers, and system contracting teams to determine preventative measures, follow-up, and resolution. Serve as a resource for others regarding coding and appeal issues.
• Provide regular statistical reports to leadership regarding rejection/denial volumes, response timeliness, success rates, identified trends, and recommendations to prevent future coding rejections/denials.
• Maintain up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally accepted coding policies and standards (e.g., NCD, LCD). Develop expertise in coding for assigned specialties. Communicate and reinforce changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinate necessary modifications and updates.
• Responsible for retrospective chart and claim coding review. Identify coding errors and recommend correct coding based on CPT, ICD-10-CM/PCS, HCPCS in accordance with coding and payer guidelines.

• Coding Associate (CCA) certification issued by AHIMA, or
• Coding Specialist - Physician (CCS-P) certification issued by AHIMA, or
• Health Information Administrator (RHIA) registration issued by AHIMA, or
• Health Information Technician (RHIT) registration issued by AHIMA, or
• Professional Coder (CPC) certification issued by AAPC, or
• Specialty Coding Professional (SCP) certification issued by BMSC.

• Advanced training beyond High School that includes completion of an accredited or approved program in Medical Coding Specialist.

• Typically requires 5 years of professional coding and at least 3 years of payer background experience in physician revenue cycle processes, health information workflows and reimbursement in a large, complex clinic or medical group.

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement.
• Advanced ability to analyze trends and data and present them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents. Knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced computer skills including Microsoft Office and familiarity with electronic coding systems or applications.
• Proficient interpersonal and written communication, with ability to collaborate across multiple departments.
• Excellent organization and prioritization skills; ability to manage multiple priorities in a fast-paced environment.
• Strong analytical skills with attention to detail.
• Ability to work independently and exercise judgment to meet deadlines in a fast-paced setting.

• Exposed to a normal office environment.
• Position may require travel with exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

#REMOTE

• Full-time

• Other

• Hospitals and Health Care