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Medical Coding Analyst
2 months ago
Position Overview
The primary responsibility of this role is to ensure precise assignment of diagnostic and procedural codes related to revenue and reimbursement for all interactions within the Administrative Support Workers framework. This involves converting patient data into alphanumeric medical codes based on treatment details, health history, diagnoses, and associated information. Adherence to CMS' Official Guidelines and other regulatory standards for ICD-9-CM/ICD-10-CM and CPT code assignments is essential.
Role Responsibilities
Individuals in this position must demonstrate proficiency in CPT and ICD coding systems, being accountable for the accurate and comprehensive assignment of ICD diagnosis codes and CPT procedure codes to maximize reimbursement and maintain coding integrity. Responsibilities include:
• Conducting thorough analysis and translation of diagnostic statements, physician orders, and relevant documentation to select appropriate code assignments.
• Coding and auditing encounters within the designated Professional Services Coding Epic queues.
• Managing daily unbilled charges to ensure timely billing in accordance with established billing and compliance protocols.
• Addressing appeals and reviewing documentation required for insurance denials to facilitate prompt resolution and reimbursement.
• Collaborating effectively in both team and individual settings, while confidently engaging with a diverse range of healthcare professionals.
• Identifying and resolving issues, establishing goals and priorities, and representing the department professionally, including in the absence of leadership when assigned.
A solid understanding of human Anatomy and Physiology, Disease Pathology, and Medical Terminology is crucial for comprehending the causes, progression, symptoms, diagnostic tests, treatment methods, and outcomes of diseases and procedures. This role requires staying updated on frequent changes in federal and state regulations regarding professional fee billing and coding, as well as being informed about new treatment methods and procedure codes. Responsibilities also encompass:
• Compliance with Professional Services Coding and Billing policies.
• Maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory updates.
• Engaging with the appropriate charging department to obtain physician clarification on diagnoses and/or procedures as needed.
• Participating in assigned performance improvement initiatives.
Required Knowledge, Skills & Abilities
1. Comprehensive understanding of coding conventions and the application of coding nomenclature consistent with CMS' Official Guidelines for Coding and Reporting ICD-9-CM/ICD-10-CM coding.
2. Familiarity with Evaluation and Management Guidelines and auditing processes to provide valuable insights to the Auditing Team for provider education and identifying potential revenue opportunities.
3. Accurate interpretation of written diagnostic descriptions to assign ICD-9-CM and ICD-10-CM diagnostic codes effectively, ensuring optimal reimbursement from various payer types, including Medicare/Medicaid and private insurance.
4. Knowledge of clinical content standards.
5. Understanding of the appeal process to guarantee accurate reimbursement.
This position does not involve direct patient care.
Minimum Qualifications
Education:
Proficiency in the English language, including reading, writing, and speaking, is required. An Associate's Degree is preferred.
Experience:
A minimum of two (2) years of prior coding experience, billing for professional services, or related fields is necessary. Relevant education may substitute for experience.
Certification:
Current AAPC Certified Professional Coder (CPC) certification, AAPC Certified Outpatient Coder (COC) certification, AHIMA Certified Coding Specialist, Physician (CCS-P), Certified Medical Coder (CMC) Certification, or the ability to obtain such certification within a specified timeframe.
Computer Skills:
Candidates must possess or be able to acquire the necessary computer skills to complete online learning requirements for job-specific competencies, access online forms and policies, and complete online benefits enrollment.
