Coding Specialist III

5 days ago


Columbia, South Carolina, United States Medstar Full time
Job Title: Coding Specialist III

MedStar Health is seeking a skilled Coding Specialist III to join our team. As a Coding Specialist III, you will be responsible for ensuring 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.

Key Responsibilities:
  • 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.
  • Contacts physician when conflicting or ambiguous information appears in the medical record.
  • 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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