Coding Specialist - Hybrid

Description

POSITION DESCRIPTION:

Responsible for the accurate and efficient coding of FHC medical records in compliance with all legal regulations and accepted standards. The Coder reviews charts as assigned by the Coding Supervisor, scans them for errors and omissions, makes edits as necessary, and submits them for processing.

DETAILED DUTIES AND RESPONSIBILITIES:

• Review accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Audits clinical documentation and coded data to validate documentation supports diagnoses, procedures and all services rendered for reimbursement and reporting purposes.
• Identifies diagnostic and procedural information and reviews physician pending charges for appropriate complexity using CPT coding guidelines.
• Assigns codes for reimbursements and compliance with regulatory requirements utilizing guidelines and following up to date coding conventions.
• Works closely with the Coding Supervisor to provide feedback to providers to improve documentation practices.
• Confirm patient demographic, insurance and referring physician information is accurately entered in Intergy.
• Enter all codes, CPT, HCPCS and ICD-10 coding and modifiers in Intergy timely and accurately.
• Follow established checks and balances systems to ensure complete and accurate code capture.
• Review Medicare Local Coverage Determinations (LCDs) and Medicare bulletin updates and Medicare NCCI.
• Serves as coding consultant to providers.
• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and third-party payers.
• Keeps abreast of standard coding guidelines (including Medicare, Medicaid, Managed Care, HEDIS, and FQHC guidelines).
• Provides updates and status reports to management weekly.
• Other duties as assigned.

Requirements

KNOWLEDGE:

• Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment
• Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage required
• Understanding of FQHC billing procedures and Sliding Fee Schedules a plus
• Understand and adhere to all HIPAA guidelines

SKILLS AND ABILITIES:

• Medical Coding & Billing course completion preferred
• 2 years Medical Coding experience preferred
• Certified Professional Coder (CPC) Certification preferred
• Minimum 1-year employment in healthcare related field