Lead Coding Reimbursement Specialist III

Lead Coding Reimbursement Specialist III

Job Summary:
Under the direction of the Revenue Cycle Director, provides day to day operational support to Coding staff, which includes Coder I & II positions. Responsibilities include but are not limited to daily monitoring of missing encounters to be coded, daily distribution of work based on priorities, execution of quality and productivity review and reporting, and support to the Coding team on processes, guidelines, and payer policies for coding functions. The position requires a high degree of collaboration with the Compliance, EMR, and Clinical Practice teams.

(This is a full time position with the ability to work remote, Monday to Friday 8 am to 5 pm)

• Perform all the responsibilities of the CRS I and CRS II positions, including charge entry and billing of appropriate CPT and ICD-10 codes for physician services into the Billing System.
• Perform various duties to accurately interpret Official Guidelines for Coding and Reporting, including educating and supporting staff daily to drop claims.
• Ensures that all members of the coding team are following official policies and standard procedures.
• Prepares staffing schedules to provide adequate coverage for all work queues and bodies of work.
• Provides feedback to RCM Leadership on exceptional and/or substandard performance.
• Provides ongoing feedback to staff on areas for improvement.
• Provides and arranges for necessary knowledge-based resources required by the coding staff to meet quality and production standards.
• Compiles, analyzes, and presents data related to coder performance, documentation issues, and charging errors.
• Lead and executes process improvement projects.
• Act as a resource regarding insurance compliance guidelines.
• Communicates documentation and charging concerns to clinical staff in conjunction with Compliance.
• Contacts physicians through query protocols regarding procedures and other services billed to ensure proper coding.
• Responsible for reviewing patient logs and other report of clinical activity to ensure billing is captured for all patients.
• Works in conjunction with the Reimbursement staff to answer all inquiries regarding coding and billing for TMP physicians' services.
• Performs other related duties as required and assigned.

Requirements:

Education and Certifications:

• Graduate of a Medical Coding Program or associate degree in healthcare related field. Experience in lieu of education may be considered.
• A minimum of five (5) years’ experience with CPT and ICD-10 coding of physician services required.
• Certification as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician Based (CCS-P), Certified Coding Associate (CCA) required. Must maintain active certification and required CEUs during employment tenure. Registered Health Information Technician (RHIT) may also be accepted in lieu of CPC.
• Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions
• Advanced knowledge of, but not limited to, Official Coding Guidelines and methodologies.
• Advanced working knowledge of medical terminology, anatomy, and physiology required.
• Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers.
• Understanding of and familiarity with regulatory guidelines including NCDs and LCDs.

Experience:

• Family Practice, Internal Medicine, Cardiology, Rheumatology, Endocrinology, Gynecology, and Dermatology preferred.
• Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions
• Advanced knowledge of, but not limited to, Official Coding Guidelines and methodologies.
• Knowledge of current third-party billing and collection regulatory guidelines and requirements.
• Good interpersonal skills and a basic understanding of team management concepts.
• Ability to gather and interpret clinical data.
• In depth knowledge of coding process, coding systems software, workflow management, and electronic medical records.
• Familiarity of automated/computerized encoders, abstracting, database, billing systems, medical records.
• Knowledge of the principles and practices of leading a team.
• Strong organizational, planning, scheduling and project management abilities .
• Excellent oral and written communication skills .
• Excellent critical thinking skills .
• Excellent analytical ability to develop and analyze data to recommend solutions and solve complex problems.
• Ability to adapt to changes in workload and work functions and to effectively prioritize work assignments.
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty and other departments

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.