Specialty Physician Coder

Job Description

Job Summary:

• Under the direction of the Coding Compliance Manager, the Specialty Physician Coder plays a key role in reviewing and analyzing specialty coding and billing for charge processing.
• This role is responsible for reviewing and accurately coding office, hospital, and surgical/procedures for reimbursement and ensuring accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients.
• The Specialty Physician Coder works with the Coding Compliance Manager on discovered coding trends, irregularities, and needed action items.

Duties and Responsibilities:

• Achievement of productivity standards as established by management.
• Achievement of quality standards as established by management.
• Analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient, and/or outpatient medical records according to established coding guidelines.
• Review and natively code surgical operative and/or procedure reports.
• Follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing and coding improvements.
• Participate in developing, implementing, and reviewing programs for coding compliance monitoring, benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
• Work in the Follow-Up and Claim Edit work queues and analyze denial trends for optimization opportunities.
• Provide ongoing and frequent communication and education to providers to maximize coding compliance and reimbursement.
• Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams.
• Work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues.
• Perform monthly coding change report analysis and oversight on provider coding change trends and communicate and educate providers as needed.
• Work weekly Missing Charge Reports to identify missed billable charges and maximize reimbursement.
• Organize, attend, and participate in specialty provider meetings.
• Prepare presentation materials for meetings.
• Document meeting minutes.
• Follow up on important action items and decisions from meetings and report to the Coding Compliance Manager.
• Take responsibility for various projects as assigned by management.
• Perform additional and miscellaneous duties as requested by the management team within the Product of knowledge and ability.
• Other duties as assigned.

Required Education:

• High School Diploma or GED.

Required Certifications & Licensure:

• AAPC- Certified Professional Coder (CPC).
• AHIMA – Certified Coding Specialist (CCS).

Preferred Certifications & Licensure:

• Specialty coding certification in a relevant specialty area (examples include, but are not limited to):
• AAPC – Certified Cardiology Coder (CCC).
• AAPC – Certified Gastroenterology Coder (CGIC).
• AAPC – Certified General Surgery Coder (CGSC).

Required Skills & Experience:

• Three (3) years of experience working in a hospital or physician’s office as a medical coder and interacting with physicians.
• One (1) year of experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, OR Radiation Oncology.
• Proficient in Microsoft Office suite.
• Proficient in Epic software.
• Strong analytical skills.
• Strong critical thinking skills.
• Detail oriented.
• Ability to anticipate, research, and resolve problems/problem-solving skills.
• Strong understanding of the healthcare revenue cycle.
• Excellent communication skills with the ability to communicate information accurately and clearly.
• Ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams.
• Ability to provide excellent customer service and address a moderate amount of incoming email and phone calls.
• Collaborative team player with the ability to adapt to the ever-changing healthcare environment.
• Professional demeanor at all times.
• Ability to handle complex and confidential information with discretion.
• Maintain patient confidentiality.
• Maintain a safe and orderly work area.
• Strong work ethic, Honest and dependable.
• Strong personal time management skills.
• Be at work and be on time.
• Follow company policies, procedures, and directives.
• Interact in a positive and constructive manner.
• Prioritize and multitask.
• Expert knowledge of ICD-10, CPT, and HCPCS.
• Strong knowledge of medical terminology, anatomy, and physiology.