Phocas Software

General Summary of Position

MedStar Health is looking for a Coding Specialist III with extensive experience in multispecialty surgical coding to join our team. To qualify for a level III Coding Specialist, you must have 5-7 years medical-professional coding experience and your CPC certification.

Job Summary - Ensures that MedStar Health's medical-professional services are coded correctly and completely, based upon extensive, complete, up-to-date knowledge of regulatory and specific payer requirements. Recommends policy and a procedural change to obtain optimum reimbursement for services rendered. In addition to interacting with physicians on coding issues, ensures that physician encounter forms, the GE IDX billing system and processes are up to date and compliant regarding coding issues. Assists manager as required. Mentors and reviews work of Coding Edit Specialist, Coding Specialist I and Coding Specialist II as required.

Primary Duties and Responsibilities

Abstracts and ensures accuracy of diagnosis, procedure, patient demographics, and other required data elements.

Aids in the creation of training and educational coding guidance documents for physicians and MMG Associates.

Assists in developing guidance to clinicians in optimizing dictations to promote compliance and claim to process.

Assists in the maintenance of billing, coding, and editing dictionaries in the billing system.

Consistently meets or exceeds established Quality, Accuracy, and Productivity standards as defined by policies.

Contacts physician when conflicting or ambiguous information appears in the medical record. Requests diagnosis from physicians when not recorded in medical records.

Determines the sequence of diagnoses for accurate claims submission.

Employs knowledge of coding compliance, and directs efforts to achieve quality standards identified through coding reviews or targeted by management for improvement.

Guides and provides mentoring related to coding projects done by Coding Specialist I and Coding Specialist II to include review and correction of code selection based upon medical documentation.

Handles complex coding case review, including but not limited to surgical coding (Orthopaedics, Cardiac, Neurosurgery, Otolaryngology, etc.) extraction, co-surgery scenarios, multi-visceral transplant cases, comorbidity evaluation.

Identifies and reports issues and trends in physician documentation and/or work routed to Coding from other departments.

Identifies coding trends relative to edits/denials/physician feedback.

Maintains continuing education and credentials as required for job classification.

Provides guidance to Coding Specialists I and II related to complex edit and appeal scenarios.

Recommends policy and procedural changes and improvements for revenue enhancement.

Surveys Medical Professional Societies coding guidelines to ensure the usage of current coding combinations and rationale.

Minimum Qualifications

Education

• High School Diploma or GED required
• Bachelor's degree preferred
• Consideration will be given to appropriate combination of education, training and experience required

Experience

• 5-7 years Medical-professional coding experience with demonstrated ability to work independently required
• 2 years' experience leading others or leading a work stream required
• Experience with computer systems for encoding and abstracting required
• Additional years of experience strongly preferred

Licenses and Certifications

• CPC (Certified Professional Coder) certification required

Knowledge, Skills, and Abilities

• Demonstrated attention to detail accompanied by outstanding organizational skills.
• Ability to interact effectively with physicians, liaisons, department administrators, and associates.
• Ability to work independently and practice self-direction.
• Working knowledge of payer policies, CMS policies, local and national regulatory and compliance policies; regular utilization of all available coding resources.
• Ability to toggle between specialty coding disciplines, including ancillary services, Anesthesia, Emergency Medicine, Radiology, Pathology and others.
• Verbal and written communication skills.
• Basic computer skills preferred.

This position has a hiring range of $28.20 - $47.30