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Coding Integrity Specialist

2 months ago

Atlanta, United States United Musculoskeletal Partners Full time
Job DescriptionJob DescriptionDescription:

SUMMARY

The Coding Integrity Specialist is responsible for reviewing and resolving coding denials and front-end edits and rejections. This position analyzes, codes, and assigns ICD-10-CM/PCS and CPT codes to specialty services such as evaluation and management (clinic), orthopedic surgery, PM&R, and physical therapy. Responsible for reviewing coding-related denials for coding accuracy and appealing them based upon coding expertise and coding judgment. Responsible for identifying and determining root causes of denials. Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals, as required by payers. In addition to promoting departmental awareness of coding best practices, the Coding Integrity Specialist follows official coding guidelines and regulatory requirements, as supported by clinical documentation in the medical record, including but not limited to, AMA CPT Official Guidelines for Coding and Reporting, CMS and other agency directives for ICD-10-CM and CPT reporting, and approved ICD-10-CM/PCS coding guidelines.


ESSENTIAL DUTIES AND RESPONSIBILITIES (Other duties may be assigned)

As a key member of the Coding team, the Coding Integrity Specialist will:

  • Analyze, evaluate, and review medical records to ensure accuracy of code assignment.
  • Determine root cause to resolve and/or appeal denials based on clinical documentation and diagnostic results, in alignment with Federal & State Coding regulations, including the National Correct Coding Initiative, CPT, HCPCS and ICD10 CM Guidelines.
  • Correct front-end charge edits and rejections.
  • Assists practices and Revenue Cycle Team with technical expertise for coding questions.
  • Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding.
  • Assists with other projects and assignments as necessary.
  • Strict adherence to AHA Coding Clinic, CPT Assistant, CMS Official Guidelines for Coding and Reporting, and approved ICD-10-CM/PCS coding guidelines.
  • Strict adherence to AHIMA’s Standards of Ethical Coding.
  • Maintain productivity standards.
  • Performs other duties as assigned.
Requirements:

QUALIFICATIONS

EDUCATION AND EXPERIENCE

  • 2+ years orthopedic surgery and/or Evaluation and Management (E/M) coding experience. Other surgical specialties considered.
  • Must have current CPC, CPMA, COSC or CEMC certification from AAPC. Will consider CCS-P or CCS certification from AHIMA, with relevant work experience.
  • Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.

SKILLS/ABILITIES

  • Must successfully pass pre-hire coding assessment.
  • Ability to consistently and accurately audit coding of physician services encounters.
  • Ability to create clear and concise audit reports and maintain productivity standards.
  • Strong technical knowledge of Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding, and official coding guidelines.
  • Knowledge of disease pathophysiology and drug utilization.
  • Knowledge of NCCI edits structure.
  • Must be detail oriented and have the ability to work independently.
  • Computer knowledge of MS Office, including Word and Excel.
  • Must display excellent interpersonal skills.
  • Ability to demonstrate initiative and discipline in time management and assignment completion.
  • Ability to work in a virtual setting under minimal supervision.


PHYSICAL DEMANDS

While performing the duties of this job, employee is regularly required to sit, stand, walk, reach with hands and arms, and to talk and hear. Employee may be occasionally required to climb or balance, stoop, kneel, or crouch. Employee must occasionally lift, push and/or move up to 30 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.


WORK ENVIORNMENT

Work may be fast-paced and intense at times. Interaction with others is constant and interruptions may occur. Schedule requires flexibility to occasionally include evenings, early mornings, and weekends.


The above describes the general content of and requirements for the performance of this position. It is not intended to be an all-inclusive statement of the duties, responsibilities, and requirements of the position.