Coding Specialist III

2 months ago

Columbia, South Carolina, United States MEDSTAR HEALTH Full time

MedStar Health is looking for a Coding Specialist III with experience in Transplant Surgery coding to join our REMOTE team with the MedStar Medical Group To qualify for a level III Coding Specialist, you must have 5-7 years medical-professional coding experience and your CPC certification.

As a Coding Specialist III you will ensure 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 IDX billing system and MMG processes are up to date and compliant regarding coding issues. Assists manager as required. Mentors and reviews work of Coding Edit Specialist, Coding Specialist I and Coding Specialist II as required.

Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move

Primary Duties:

  • Abstracts and ensures accuracy of diagnosis, procedure, patient demographics, and other required data elements.
  • Aids in the creation of training and educational coding guidance documents for physicians and MMG Associates. Assists in developing guidance to clinicians in optimizing dictations to promote compliance and claim to process. Assists in the maintenance of billing, coding, and editing dictionaries in the billing system.
  • 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, and 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 Specialist II to include review and correction of code selection based upon medical documentation.
  • Handles complex coding case review, including but not limited to surgical coding (Orthopaedics, Cardiac, Neurosurgery, Otolaryngology, etc.) extraction, co-surgery scenarios, multi-visceral transplant cases, comorbidity evaluation.
  • Identifies and reports issues and trends in physician documentation and/or work routed to Coding from other departments. Identifies coding trends relative to edits/denials/physician feedback.
  • Recommends policy and procedural changes and improvements for revenue enhancement.
  • Surveys Medical Professional Societies coding guidelines to ensure the usage of current coding combinations and rationale.


Qualifications:

  • High School Diploma or GED required; Bachelor's degree preferred
  • CPC (Certified Professional Coder) certification required
  • 5-7 years Medical-professional coding experience with demonstrated ability to work independently required
  • 2 years' experience leading others or leading a work stream required
  • Experience with computer systems for encoding and abstracting required
  • Ability to interact effectively with physicians, liaisons, department administrators, and associates.
  • Ability to work independently and practice self-direction.
  • Working knowledge of payer policies, CMS policies, local and national regulatory and compliance policies; regular utilization of all available coding resources.

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