Medical Coding Specialist

2 weeks ago

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

Role Summary:

The Coding Specialist collaborates with medical professionals, fellow coders, and insurance providers. This position involves occasional abstract coding, resolving claim discrepancies, and engaging in denial management processes. Additionally, Coding Specialists:

  • Adhere to Orthopaedic Solutions Management policies and procedures while implementing federal and state coding regulations.
  • Interpret and follow up on Explanation of Benefits.
  • Conduct timely account reviews by monitoring account activities and ensuring optimal reimbursement.
  • Maintain the quality and quantity of assigned tasks.

Key Duties:

  • Identify the correct codes and modifiers for all billable services using ICD10 CM, CPT, and HCPCS or specific payer guidelines.
  • Code 100% of medical records/encounters for each designated clinic or encounter type when available.
  • Analyze and resolve coding-related issues.
  • Extract codes from medical documentation.
  • Possess knowledge of Spine Codes.
  • Take necessary actions on denied claims to ensure payments are processed on the first follow-up or appeal.
  • Manage assigned queues, aging, and denial reports to meet position goals.
  • Learn and adhere to payer guidelines.
  • Inform management of any changes in payer policy coding.
  • Ensure timely submission of accurate information to insurance companies to facilitate payment.
  • Comprehend 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 policies and procedures established by Orthopaedic Solutions Management.
  • Perform other duties as assigned.

Qualifications:

  • A minimum of five (5) years of healthcare coding experience with ICD-10-CM, PCS, CPT, and DRG classification systems, demonstrating a thorough understanding of data quality impacts on payment, utilization, and reimbursement across various medical specialties.
  • At least two (2) years of healthcare coding experience specifically focused on spine.
  • Coding Certification: CCS, CCS-P, CPC, CPC-H, CCA, COC, RHIT, RHIA, or NRCCS.
  • High school diploma or equivalent (GED).
  • Familiarity with 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 (e.g., Athena, FileMaker, Incisions) and Select Coder Assisted Coding encoder.

Preferred Certifications:

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 endorsed 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.

Additional Skills:

  • Understanding of ICD10, CPT, HCPCS, and modifier usage.
  • Experience in surgical coding.
  • Familiarity with CMS 1500 completion.
  • Experience with Athena.
  • Prior coding experience, preferably with a focus on Spine.
  • An active coding certification.

At Orthopaedic Solutions Management, we are dedicated to delivering exceptional orthopedic care.

Our mission encompasses not only the clinical care provided by physicians but also all medical and administrative interactions throughout the patient experience. Every team member plays a crucial role in this mission. We are proud to support our employees, including those in the National Guard and Reserve, and are committed to fostering a culture of inclusion that reflects the communities we serve, providing equal opportunities for all.

What We Offer:

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

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