The Coding and Reimbursement Specialist is responsible for reviewing, analyzing, and accurately coding ambulatory and/or hospital-based encounters. This role performs initial charge review for E/M visits, diagnostic tests, and procedures across multiple specialty departments to determine the appropriate assignment of CPT, ICD-10, HCPCS codes, and modifiers for reporting physician services to third-party payers. The Specialist ensures all coding aligns with established coding standards, regulatory requirements, and reimbursement policies.
Essential Duties and Responsibilities:
- Analyzes provider documentation to assure the appropriate Evaluation & Management levels are assigned using the correct CPT and current Evaluation and Management Guidelines
- Interprets outpatient office visit notes and charge documents to determine services provided and accurately assign CPT , Modifiers, and ICD-10 coding to these services.
- Performs comprehensive review of encounter note to assure all vital information such as patient identification, signatures, attestation, and dates are present in the record.
- Evaluate documentation for consistency and adequacy. Ensure diagnosis accurately reflects the care and treatment rendered.
- Monitors and follows up to ensure all services billed are captured and coded.
- Follows and adheres to all WWT policies such as Coding Audit Policy and Physician Coding Query In-Basket Policy
- Provide real time feedback to providers on all coding changes and trends via EPIC in basket message
- Regularly participate and engage in coding team meeting.
- Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.
- Works in coordination with other members of the physician's office/departments as necessary.
- Collaborates with Coding Management for special coding and billing projects if assigned.
- Apply coding knowledge and skills to resolve coding denials from payers and works with management and various departments.
- Resolving coding denials assigned by applying coding knowledge and skills.
- Maintains active coding credentials and CEU's required for coding roles.
- Performs other related duties as required and assigned.
Knowledge, Skills & Abilities
- Knowledge and understanding of medical coding and billing systems and regulatory requirements
- Communication - communicates clearly and concisely, verbally and in writing.
- Persistence – comfortable pursuing, rebutting and escalating issues as appropriate.
- Goal-oriented – holds him/herself accountable to achieving shared professional and personal goals.
- Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
- Interpersonal skills – establishing and maintaining effective working relationships with employees, and external parties.
- PC skills - demonstrates high proficiency in Microsoft Office applications, especially Microsoft Excel, and others as required.
- Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.
Education/Experience:
- Certified professional coder CCS-P, CPC, RHIT or RHIA through AAPC or AHIMA with a minimum of two years' experience with CPT/ICD-10 coding of multispecialty services preferred. Responsible for maintaining continuing education per certification requirements.
- Clear understanding of protocols and procedures in a medical office including health information management, confidentiality, and safety.
- Organize and prioritize responsibilities while remaining flexible to changing demands.
- Excellent written and oral communication skills, with the ability to interact with patients, families, staff and others.
- Strong analytical skills and attention to detail
- Ability to establish priorities and work independently
- Must have high level of discretion and judgment.