Medical Billing & Coding Specialist

Southwest Network•Phoenix, AZ

10d

About The Position

This role involves auditing charts and clinical records to ensure adherence to diagnostic and procedural coding guidelines. The specialist will identify trends in improper coding that could lead to claim denials or audits, and stay updated on evolving regulatory and industry changes. They will provide education and coaching to medical specialties based on audit findings, clarify information with providers, and collaborate with IT and EHR teams to optimize workflows. The position also requires conducting ad-hoc audits and serving as an expert on coding practices. A key aspect is analyzing medical records to identify documentation deficiencies.

Requirements

Strict adherence to diagnostic and procedural codes and modifiers.
Identification of trends in improper coding.
Compliance with medical coding guidelines.
Monitoring of regulatory and industry changes.
Provision of education, coaching, and training programs.
Clarification of information with rendering providers.
Collaboration with IT and EHR teams.
Conducting ad-hoc audits.
Expertise in accurate and efficient coding practices.
Analysis of medical records for documentation deficiencies.
Adherence to policies and procedures.
Adherence to Corporate Compliance Program requirements.
Ensuring confidentiality of information.
Adherence to HIPAA standards.
Adherence to legal, ethical, and professional guidelines.

Responsibilities

Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere.
Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits.
Complies with all medical coding guidelines and monitors evolving regulatory and industry changes.
Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings.
Follows up and clarifies any information that is not clear with the rendering provider.
Collaborates with IT and EHR teams to improve charge automation and optimize workflows.
Conducts ad-hoc audits to ensure fidelity to coding guidelines.
Acts as a relevant expert for Southwest Network on accurate and efficient coding practices.
Analyzes medical records and identifies documentation deficiencies.
Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program.
Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical and professional guidelines adopted by Southwest Network.
Performs other duties as assigned.