Coding Reimbursement Specialist II
Job Summary:
The Coding Reimbursement Specialist II performs various duties to accurately interpret and bill physician charges for physician services by entering into the appropriate CPT, ICD-10, and modifiers into the Billing system.
(This is a full-time hybrid or remote position that will support the RCM team, Monday to Friday 8 am to 5 pm)
Primary Job Responsibilities/Tasks may include, but not limited to:
- Performs initial charge review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers.
- Interprets progress notes, operative reports, discharge summaries, and charge documents to determine services provided and accurately assign CPT and ICD-10 coding to these services, according to guidelines established by the AMA.
- Enter appropriate data into the TMP billing system by selecting the appropriate codes, diagnosis, modifiers, to complete the charge process.
- Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met.
- Contacts physicians through query protocols regarding procedures and other services billed to ensure proper coding.
- Responsible for reviewing patient logs and other report of clinical activity to ensure billing is captured for all patients.
- Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.
- Works in conjunction with the Reimbursement staff to answer all inquiries regarding coding and billing for TMP physicians' services.
- Performs other related duties as required and assigned.
Requirements:
Education and Certifications:
- High school diploma or GED completion is required.
- A minimum of three (3) years' experience with CPT and ICD-10 coding of physician services required.
- Coding certification required. CPC Certification preferred. Must maintain active certification and required CEUs during employment tenure.
- Advanced working knowledge of medical terminology, anatomy, and physiology required.
- Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers.
- Understanding of and familiarity with regulatory guidelines including NCDs and LCDs.
Experience:
- Family Practice, Internal Medicine, Cardiology, Rheumatology, Endocrinology, Gynecology, and Dermatology preferred.
- Knowledge of current third-party billing and collection regulatory guidelines and requirements.
- Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions.
- Advanced knowledge of, but not limited to, Official Coding Guidelines and methodologies.
- Knowledge of current third-party billing and collection regulatory guidelines and requirements.
- Good interpersonal skills and a basic understanding of team concept.
- Ability to gather and interpret clinical data.
- Ability to work independently in a fast-paced environment.
Physical Requirements:
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds.
- Ability to concentrate on details.
- Use of computer for long periods of time.