Specialty Physician Coder

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, ensuring accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients.
• The Specialty Physician Coder will also collaborate with the Coding Compliance Manager to identify coding trends, irregularities, and required action items.

Essential Functions and Responsibilities:

• Meet productivity standards established by management
• Meet quality standards established by management
• In adherence with standard work, analyze and interpret medical records and assign and sequence appropriate ICD-10-CM, CPT, and/or HCPCS codes for office, inpatient, and/or outpatient records according to established coding guidelines, including the ability to review and code surgical operative and/or procedure reports
• Follow established workflows for claim denials in Follow-Up work queues, identify opportunities for billing/coding improvements, and participate in coding compliance monitoring, benchmarking, policy development, and physician documentation improvement programs
• Analyze denial trends and optimize processes within Follow-Up and Claim Edit work queues
• Provide ongoing communication and education to MCMF providers to maximize coding compliance and reimbursement
• Adhere to Coding Compliance department communication standards and collaborate with Physician Billing Services Insurance and Customer Service teams to resolve billing and coding issues
• Perform monthly coding change report analysis and communicate trends to 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, document meeting minutes, follow up on action items, and report to the Coding Compliance Manager
• Take responsibility for assigned projects and perform additional duties as requested by management
• Other duties as assigned.

Experience:

• 3 years of experience working in a hospital or physician’s office as a medical coder, including interaction with physicians
• 1 year of experience as a specialty coder in one of the following: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, or Radiation Oncology
• Epic software experience highly preferred.
• Cardiology and Cardiac Surgery Experience:
• Strong Evaluation and Management (E/M) inpatient and outpatient coding experience
• Must reside in CA but can work remotely
• Proof ONLY – NOT HCC/risk adjustment, ASC, or facility coding
• Desire to convert to full-time employment
• Experience working on denials
• GI (CGIC coding certification) or OBGYN (COBGC coding certification) coding experience (1 year or more)

Knowledge, Skills, and Abilities:

• Strong critical care knowledge.
• Must be able to abstract chart reviews to capture all billable charges
• CCC certification required
• Must be knowledgeable in heart catheterizations
• Expert knowledge of ICD-10, CPT, and HCPCS
• Strong knowledge of medical terminology, anatomy, and physiology
• Proficient in Microsoft Office
• 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 with strong problem-solving skills
• Strong understanding of the healthcare revenue cycle
• Excellent communication skills with the ability to convey information accurately and clearly
• Ability to manage interpersonal relationships and communicate effectively with clinical partners and business center teams
• Provide excellent customer service and manage a moderate volume of incoming emails and phone calls
• Collaborative team player with the ability to adapt to a dynamic healthcare environment
• Maintain a professional demeanor at all times
• Ability to handle complex and confidential information with discretion
• Maintain patient confidentiality
• Maintain a safe and organized work area
• Strong work ethic; honest and dependable
• Strong personal time management skills
• Maintain regular attendance and punctuality
• Follow company policies, procedures, and directives
• Interact in a positive and constructive manner
• Ability to prioritize and multitask