Coding Quality Specialist 2 - Orthopedic Surgery/Musculoskeletal
About The Position
Assigns and reviews the accuracy of the diagnostic codes (ICD-10-CM) and CPT codes for providers’ Evaluation and Management Services (E/M), procedures and diagnostic testing in all settings for purposes of billing, research and providing information to government and regulatory agencies. These roles are responsible for translating patient diagnoses, treatments, and procedures into standardized medical codes. Medical coders ensure accurate coding to support billing processes, comply with regulations, and maintain the integrity of patient health records for reimbursement and reporting purposes.
Requirements
- High School Diploma or GED required.
- 2+ years of relevant coding experience required.
- Certified Professional Coder (CPC) required.
Responsibilities
- Reviews documentation in medical record to appropriately assign ICD-10-CM, CPT-4, HCPCS and modifiers within a timely manner to capture all services rendered by providers at all locations. Encounters may be within Epic, outside electronic medical record systems, or based on paper documentation.
- Reviews and resolves charge sessions that fail charge review edits, claim edits and follow-up work queues, identifies areas of opportunity based on findings/resolution of errors.
- Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.
- Assists physicians/providers with questions regarding coding and documentation guidelines.
- Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to coding leadership and/or provider education team.
- Ensures all coded services meet appropriate governmental regulations and guidelines, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
- Utilizes available resources for assignment of codes as necessary (e.g., Diagnostic Imaging system, Lab system, Emergency, Epic, and coding reference software and/or books).
- Trains and provides mentorship to Coding Quality Specialist Level 1 staff to effectively perform their job responsibilities following current coding policies and procedures at the discretion of coding leadership.
- Assists coders with medical terminology, disease processes and surgical techniques.
- Assists other coders in resolving coding issues/questions.
- Performs peer review as directed from coding leadership.
- Queries physicians to obtain clarification or missing elements in the record preventing correct coding.
- Performs other duties as assigned.
Benefits
- Medical, Dental, and Vision Insurance
- Paid Time Off
- Long-term and Short-term Disability
- Retirement Savings
- Health Saving Plans
- Flexible Spending Accounts
- Certification and education support
- Generous Paid Time Off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
