Coding Specialist

Overview

Responsibilities

Under the direct supervision of the Medical Coding Manager the Coding Specialist is responsible for coordinating and participating in the coding of pertinent medical information from a variety of complex records and coding edits to include diagnosis, treatment of illness and procedures performed while ensuring accuracy of work adherence to established coding procedures of ICD-CM (International Classification of Diseases) and CPT-4 (Current Procedural Terminology). Applications utilized are: Excel, Word, 1st Class E-Mail, Outlook, Master Database, BabySteps, various EHR applications and NextGen EHR and EPM.

• Reviewing all pertinent medical records for diagnosis and procedures performed and documented while maintaining strict adherence to MEDNAX Compliance program guidelines.
• Timely and appropriate coding of Neonatal and Pediatric services, Pediatric Cardiology, Perinatology, Developmental and Pediatric surgery services as required to meet production needs.
• Participation in the OBR (Online Billing and Registration) and NextGen EPM process by entering and/or verifying all valid diagnoses, procedure codes and modifiers discovered upon medical review of records via Claims Manager reports.
• Communicate to physicians by Electronic Mail all discrepancies in coding based on the medical record reviewed.
• Review and educate physicians, neonatal nurse practitioners and other staff as necessary on documentation requirements and coding guidelines.
• Communicates to Coding management any Claims Manager updates as needed.
• Review claim denials from Patient Accounts through the EEC process.
• Research and review with Patient Account associates for clarification of third party payer queries.
• Participates in audit, education and coding team meetings to discuss solutions to coding guidance
• Meet or exceed required departmental productivity standards on a consistent basis.
• Performs a variety of other Coding Compliance duties as needed.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policy.
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
• Performs other job-related duties within the job scope as requested by Management of Coding.
• Embodies the principles of the corporate Mission Statement and Philosophy at all times.
• Complies with departmental and company-wide policies and procedures.

Qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P) designation required with current active status.
• Clinical background or minimum of three years related experience and/or training; or equivalent combination of education and experience preferred in addition to certification
• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and communicate them to physicians, coders, and other staff in a way that facilitates understanding.