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Coding Specialist

2 months ago

San Francisco, California, United States GoHealth Urgent Care Full time
Job Summary

The Coding Specialist at GoHealth Urgent Care coordinates medical record coding audits, conducts provider training sessions on diagnosis coding, and develops training guidelines, processes, and procedures to maximize reimbursement.

Key Responsibilities
  • Perform coding audits to ensure procedure codes are accurate based on diagnosis.
  • Review medical record documentation that supports billing, risk management, and legal requirements.
  • Maintain accurate records of provider audits and make recommendations for changes in policies and procedures, guidelines, and training programs.
  • Work closely with Corporate Compliance to identify areas of opportunity in medical record coding and documentation for Providers.
  • Develop and implement onsite education and training to ensure accurate documentation and medical coding in real-time.
  • Provide consultation to Providers to improve medical record documentation and ensure proper coding to maximize claim reimbursement.
  • Develop and implement coding education for new hire Providers.
  • Perform data analysis and evaluate denial reports of all payers; develop reports on physician statistics regarding coding compliance, benchmarking, and revenue enhancement opportunities.
  • Participate in committees and meetings related to coding, billing, and documentation.
  • Prepare written reports of audit findings by provider/practice.
  • Assist with claim denial reports to ensure optimal reimbursement.
  • Provide clarification on GoHealth coding and compliance policies.
  • Meet with the Compliance Committee as needed to review audits, discuss concerns, and develop processes/procedures.