Specialty Physician Coder

Role Requirements:
Surgical breast oncology (including plastic reconstructive breast surgery), Hematology/Oncology
Must be able to abstract the chart review to capture all billable charges
EPIC experience: charge entry and charge review experience required
Strong Evaluation and Management (E/M) inpatient and outpatient coding experience
Must reside in CA but can be remote
Profee ONLY NOT HCC/risk adjustment, ASC, or facility coding
Desire to convert to full-time employment

Bonus/nice to have:
Bonus: GYNONC coding experience
Bonus: Experience working on denials
Bonus: GI (CGIC coding certification) or OBGYN (COBGC coding certification) coding experience (1 year or more)
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 will be 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 will also work with the Coding Compliance Manager on discovered coding trends and irregularities and needed action items.

Essential Functions and Responsibilities of the Job

• Proficient in Microsoft Office suite.
• Proficient in Epic software.
• Strong analytical skills.
• Strong critical thinking skills.
• Detail oriented.
• The ability to anticipate, research, and resolve problems/strong problem-solving skills.
• Strong understanding of the healthcare revenue cycle.
• Excellent communication skills with the ability to communicate information accurately and clearly.
• The ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams.
• 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.
• The 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.

Skills:

• Achievement of productivity standards as established by management.
• Achievement of quality standards as established by management. In adherence with standard work, 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, including the ability to review and natively code surgical operative and/or procedure reports.
• In adherence with standard work, follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs. Optimization opportunities include but are not limited to, working in the Follow-Up and Claim Edit work queues and analyzing denial trends.
• In adherence with standard work, provide ongoing and frequent communication/education to MCMF providers to maximize coding compliance and reimbursement. Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams and work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues. Perform monthly coding change report analysis/oversight on provider coding change trends and communicate/educate the providers, as needed.
• In adherence with standard work, work weekly Missing Charge Reports to identify missed billable charges to maximize reimbursement.
• In adherence with standard work, organize, attend, and participate in specialty provider meetings. Prepare presentation materials for meetings, document meeting minutes, follow up on important action items/decisions from meetings, and report to the Coding Compliance Manager.
• In adherence with standard work, take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the Product of knowledge/ability.
• Other duties as assigned.

Experience:
3 years experience working in a hospital or physicians office as a medical coder and interacting with physicians.
1 years experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, or Radiation Oncology.
Expert knowledge of ICD10, CPT, and HCPCS.
Strong knowledge of medical terminology, anatomy and physiology.
Epic software experience is highly desired.
Proficient Microsoft skills.