Provider Coding Specialist

Employee Type:Regular

Work Shift:Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Provider Coding Specialist

Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day.

A Brief Overview

Under the supervision of the Coding Supervisor, the Provider Coding Specialist is responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT, and HCPCS codes to professional surgical patient accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Organization policy and procedure. Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responsible for resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement of service rendered and to maintain an industry standard clean claim rate.

What you will do

Analyze medical records, interprets documentation, and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD 10 CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), and modifiers utilizing designated software, coding manuals and other reference material as required

Enter charges for procedures that are not soft coded as instructed for certain patient types

Consistently meet coding quality and productivity standards established by the coding department

Work closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions. Assist with coding inquiries from billing and administrative staff, ensuring that accurate codes are applied for appropriate reimbursement

Gather and verify all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract

Review and resolve clearinghouse rejection errors, denials, and charge review/claim edits daily. Also reviews accounts returned from various departments and processes corrections for clean claim submission

Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations

Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record. Query providers for clarification on incomplete or ambiguous documentation and follow up to ensure timely resolution

Review and code Orthopedic, OB/GYN, and other surgical specialties procedures with minimal supervision, ensuring correct coding and sequencing of diagnoses and procedures

Provide continuous education and feedback to surgeons and clinical staff regarding ICD-10 coding and documentation best practices for surgical procedures

Education Qualifications

High School Diploma Required

Experience Qualifications

2+ years of abstract coding for physician services Required

Minimum of four years of healthcare experience, with at least three years of professional coding experience in Orthopedics or OB/GYN Required

Experience working remotely Preferred

Skills and Abilities

Basic knowledge of ICD 10-CM diagnostic and CPT/HCPCS procedure codes principles and guidelines

Basic knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and metric systems

Basic knowledge of Standards of Ethical Coding

Skills and ability to communicate effectively both orally and in writing

Skills and ability to maintain working relationships with physicians and other staff

Skills and ability to review the work of others and maintain confidentiality

Knowledge of Microsoft Applications including (Excel, Word, PowerPoint, Outlook, etc)

Strong analytical capabilities

Strong organizational skills

Advanced ability to function independently and be a self-starter

Outstanding research skills and ability to use independent judgment to solve problems

Handle multiple priorities

Listen and acknowledge ideas and expressions of others attentively

Converse clearly using appropriate verbal and body language

Collaborate with others to achieve a common goal through cooperation

Influence others for positive and productive outcomes

Review medical record documentation and ensure accurate diagnosis and procedure code assignment to patient records

Expertise in assigning accurate CPT®, HCPCS Level II, and ICD-10-CM medical codes and modifiers based on coding and payer guidelines.

Maintain a solid understanding of anatomy, physiology, and medical terminology as required to accurately code provider services and diagnoses

Licenses and Certifications

Registered Health Information Administrator - American Health Information Management Association Required or

Registered Health Information Technician - American Health Information Management Association Required or

Certified Coding Specialist - American Health Information Management Association Required or

Certified Coding Specialist - Physician-based - American Health Information Management Association Required or

Certified Coding Associate - American Health Information Management Association Required

Physical Demand

Light Physical Demand

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.

Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.

JR104049

Remote/Remotely/Tele/Telecommute/From home