Medical Coding Specialist

Role Overview

• Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types
• The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided
• When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX
• Correctly abstract required data per facility specifications
• Perform "medical necessity checks" for Medicare and other payers as required per payment guidelines
• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensure timely, compliant processing of outpatient claims in the billing system
• Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards
• Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through
• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC) Medical Necessity software, abstracting system, code books, and all reference materials
• Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy
• Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth

Requirements

• 1 year of previous coding experience
• PC and Computer application knowledge and experience
• Navigational and basic functional expertise in Microsoft business software (Excel, Word, PowerPoint)
• Excellent organization skills, communication, time management, troubleshooting and problem solving
• Ability to multi-task and prioritize needs to meet short
• and long-term timelines
• Experience with EPIC and previous use of coding software tools
• AAPC or AHIMA Coding Certification: CPC-A, CPC, CCA or CCS

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement