Coding Specialist Senior

The Senior Coding Specialist is responsible for performing coding tasks required to promote efficient operation of the physician practices within Chesapeake Regional Medical Group.

Essential Duties and Responsibilities

The duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.

• Obtain pathology and operative reports from hospital systems.

• Assign and sequence ICD diagnostic, procedural, and CPT codes to ASC records.

• Identify all complicating conditions/co-morbidities to ensure optimum reimbursement.

• Maintain established productivity requirements.

• Accurately enter various code and charge information into information systems.

• Review appropriate reports for validation of accurate transmission.

• Resolve transmission errors and resubmit claims.

• Report all payments on collection claims to the Collections Specialist(s).

• Attend required hospital-wide orientations, meetings, and in-services.

• Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care.

• Complete all assigned charge entry, coding, billing, and follow-up in a timely manner.

• HOLD Bucket/worklist; assist and train Billing Representatives for all practices, departments, and locations.

• Provide back-up phone coverage for all practices, departments, and locations, including patient statement calls and CRMG, CRNI, and SAS staff support.

• Process refunds and train staff on refunds for all practices, departments, and locations.

• Manage AIR Aging Wizard activities for all practices, departments, and locations.

• Conduct internal audits for all practices, departments, and locations.

• Support new practice go-live implementations.

• Demonstrate comprehension of payer guidelines for appeals, overpayments, retractions, refunds, eligibility, reconsiderations, referrals, authorizations, payer websites, filing limitations, denials, and attachment requirements to work all claims to a zero balance in a timely manner.

• Retrieve clinical or financial documents from other scanning programs (e.g., OnBase).

• Handle Release of Information requests.

• Participate in and attend approved healthcare/insurance webinars and seminars.

• Maintain up-to-date working knowledge of assigned payors, LCD/NCO, CPT, and ICD-9/ICD-10.

• Attend and participate in monthly billing meetings.

• Report to manager on a weekly or monthly basis regarding scheduled and assigned tasks/projects.

• Create cases for coding team members for any claims in assigned worklists that pertain to coding issues.

• Provide front desk support following go-live implementation of new electronic medical records.

• Possess the ability to fill in as a Patient Service Representative as directed by the manager.

Reporting Structure

Reports To: Practice Office Manager
Supervises: None
Responsibilities: Not applicable

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Required Education

• High School Diploma

Preferred Education

• Courses in Medical Terminology and Ancillary Testing

Experience

• One or more years of hospital and/or medical office experience.

• Typing speed of 35+ words per minute.

• Proficient knowledge of computer functions and operations.

Certification Requirement

Applicant must have current Certified Professional Coder (CPC) certification or obtain CPC certification within one year of hire date.