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Healthcare Coding Analyst

2 months ago

Tampa, Florida, United States Orthopaedic Solutions Management Full time
Position Overview

In this position, you will:

The Medical Coding Specialist collaborates with healthcare professionals, fellow coders, and insurance providers; engages in occasional abstract coding, addresses claim discrepancies, and participates in denial resolution. Furthermore, Coding Specialists:

  • Adhere to Orthopaedic Solutions Management policies and procedures while applying federal and state regulations to coding practices.
  • Interpret and follow up on Explanation of Benefits.
  • Conduct timely reviews of accounts by tracking account activity and providing necessary follow-up to ensure optimal reimbursement.
  • Maintain the quantity and quality of assigned tasks.

Key Duties

  • Identify the appropriate codes and modifiers for all billable services using ICD10 CM, CPT, and HCPCS or payer-specific guidelines.
  • Code 100% of medical records/encounters for each designated clinic or encounter type when available.
  • Recognize and analyze problems or issues.
  • Abstract codes from medical documentation.
  • Possess knowledge of spine coding.
  • Take necessary actions on denied charges to ensure claims are paid promptly on the first follow-up or appeal.
  • Manage assigned queues, aging, and denial reports to meet the established goals for the role.
  • Be responsible for learning, understanding, and adhering to payer guidelines.
  • Notify management of changes in payer policy coding.
  • Ensure accurate information is submitted to insurance companies to expedite payment.
  • Work to comprehend the operative notes that dictate billed procedures.
  • Engage in special assignments as required.
  • Utilize coding resources (CPT, ICD-10, CDR, AAOS books, Select Coder) to understand denied procedures.
  • Document accounts accurately.
  • Ensure compliance with all company plans, policies, and procedures established by Orthopaedic Solutions Management.
  • Perform other duties as assigned.

About You:

  • At least five (5) years of healthcare coding experience with ICD-10-CM, PCS, CPT, and DRG classification systems, with a solid understanding of the impact of data quality on prospective payment, utilization, and reimbursement across various medical specialties.
  • A minimum of two (2) years of healthcare coding experience specifically in spine coding.
  • Coding Certification: CCS, CCS-P, CPC, CPC-H, CCA, COC, RHIT, RHIA, or NRCCS.
  • High school diploma or equivalent (GED).
  • Knowledge of medical terminology and coding practices, along with experience in insurance collection and denial processes (minimum of 5 years).
  • Proficient in computer skills (Microsoft Office Suite, general EMR knowledge, payer websites).
  • Experience with automated patient care and coding systems (Athena, FileMaker, Incisions) and Select Coder Assisted Coding encoder.

*Required certifications include:

Certified Professional Coder ("CPC"), Certified Professional Coder-Hospital ("CPC-H"), Certified Coding Specialist ("CCS"), Certified Coding Specialist-Physician-based ("CCSP"), Radiation Oncology Certification Coder ("ROCC"), Certified Interventional Radiology Coder ("CIRCC"), or any certification sponsored by the American Academy of Professional Coders ("AAPC"), Registered Health Information Technician ("RHIT"), or Registered Health Information Administrator ("RHIA"). Other accredited coding certifications may be considered.

Preferred Qualifications:

  • Familiarity with ICD10, CPT, HCPCS, and the application of modifiers.
  • Experience in surgical coding.
  • Knowledge of CMS 1500 completion.
  • Experience with Athena.
  • Prior coding experience, preferably with a focus on spine.
  • An active coding certification.

At Orthopaedic Solutions Management, our mission is to deliver exceptional orthopedic care to our patients.

We are dedicated to providing the highest quality of care, encompassing not only the clinical aspects but also all administrative components of the patient experience. Every team member plays a crucial role in this mission. We take pride in fostering a culture of inclusion that reflects the communities we serve, ensuring equal opportunities for all. Orthopaedic Solutions Management adheres to all applicable laws and regulations.

What We Offer:

  • Full-time remote opportunities available, with potential for career advancement.
  • Excellent job security and stability, promoting a healthy work-life balance.
  • Become part of a dynamic and growing high-level Coding Team.