Medical Billing & Coding Specialist

Southwest Network Company Brand•Phoenix, AZ

About The Position

The Medical Billing & Coding Specialist will audit charts and review clinical records to ensure all diagnostic and procedural codes and modifiers strictly adhere to guidelines. This role involves identifying trends in improper coding or communication shortcomings that may lead to claim denials or audits, and complying with all medical coding guidelines while monitoring evolving regulatory and industry changes. The specialist will provide targeted education, direct coaching, and facilitate training programs tailored to each medical specialty based on audit findings. They will also follow up and clarify information with the rendering provider, collaborate with IT and EHR teams to improve charge automation and optimize workflows, and conduct ad-hoc audits to ensure fidelity to coding guidelines. This position serves as a relevant expert for Southwest Network on accurate and efficient coding practices and analyzes medical records to identify documentation deficiencies. Nonessential functions include following policies and procedures, adhering to the Corporate Compliance Program, ensuring confidentiality in accordance with HIPAA standards and Southwest Network policy, and adhering to legal, ethical, and professional guidelines.

Requirements

Strict adherence to diagnostic and procedural codes and modifiers.
Ability to identify trends in improper coding and communication shortcomings.
Compliance with medical coding guidelines.
Monitoring of evolving regulatory and industry changes.
Ability to provide education, coaching, and training.
Skill in clarifying 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 to identify documentation deficiencies.
Adherence to policies and procedures.
Adherence to Corporate Compliance Program requirements.
Ensuring confidentiality of information per HIPAA standards and company policy.
Adherence to legal, ethical, and professional guidelines.

Responsibilities

Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere to guidelines.
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.
Serves 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.
Adheres to the legal, ethical, and professional guidelines adopted by Southwest Network.
Performs other duties as assigned.