Reimbursement Coding Specialist

Position Summary The Reimbursement Coding Specialist will analyze complex physician and ancillary medical billing charges to verify correct documentation and assign the correct codes to obtain the maximum reimbursement allowed by the payers. Performs other coding-related functions including training new coding staff, education other billing staff on correcting and resubmitting denied claims, serves as a coding resource/liaison, interfaces with outside auditors and research mandated coding/billing changes to determine the proper course of action. Works under the general supervision of the Revenue Cycle Billing Manager. Duties Responsibilities Reviews Maintains an expert level of knowledge of CPT, ICD-10 and HCPCS coding principles, modifier usage, medical terminology, HIPAA compliance, governmental regulations and third-party payer requirements pertaining to billing, coding and documentation. Codes highly complex services, maintaining departmental standards for productivity and accuracy. Works under minimal supervision using specialized expertise in the subject matter. Ensuring all services documented in the patient's medical record are coded with appropriate diagnoses and procedure codes. When services are not documented appropriately, they seek proper documentation in a timely manner based upon established protocols. Acts as a knowledge resource to provider education regarding code matters and provides feedback on how to improve documentation and charge capture to ensure revenue optimization. Identifies risk areas and error trends for providers, procedures, facilities and/or coders. Understands HIPPA regulations, treats all patient information and data with complete confidentiality and takes all precautions to secure this information. Research and resolve coding related system edits, payer rejections, and insurance denials. Serves as a mentor and trainer to less experienced coders and answers questions as needed. Perform other duties and participate in special projects as assigned. Attends and participates in departmental staff meetings, coding meetings, or other meetings as requested.