Coding Specialist II - Professional Multispecialty Surgical

MedStar Health is looking for a Coding Specialist II with experience in Professional Multispecialty Surgical coding to join our remote team! Surgical specialties include, but not limited to, pain management, ophthalmology, urology, womens health, ENT and neurology. To qualify for a level II Coding Specialist, you must have 3-4 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 Specialists, Coding Specialist I as required.
Education

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

Experience

• 3-4 years medical-professional coding experience with demonstrated ability to work independently required
• 1-2 years Leading others or leading a work stream required
• Experience with computer systems for encoding and abstracting required

Licenses and Certifications

• CPC (Certified Professional Coder) certification required

Knowledge, Skills, and Abilities

• 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.
• Ability to communicate and deal with physicians in a professional, articulate manner and understand medical terminology specific to body systems.
• In-depth knowledge of billing process, including, but not limited to, claims submission, whether manual or electronic, different payer requirements re: modifiers and correct diagnosis/procedure linkage.
• Broad, deep medical knowledge, including but not limited to: extensive knowledge of medical terminology, knowledge of human anatomical systems/body systems, and knowledge of medical procedures performed by physicians, nurses and allied health workers.
• Working knowledge of payer policies, HCFA policies, local and national regulatory and compliance policy, knowledge of all available coding resources.
• Basic computer skills preferred.

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

Accesses and understands coding software used by hospital coders, as a verification/cross check tool to ensure that technical component coding done by hospital coders and professional component coding is synchronized correctly on accounts involving both billing components (example: Radiology coding).

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

Assists in the maintenance of billing, coding and edit 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, 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 Edit Specialist to include review and correction of code selection based upon medical documentation.

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

Maintains continuing education and credentials as required for job classification.

Recommends policy and procedural changes and improvements for revenue enhancement.