Outpatient Physician Coding Specialist

CGH Medical Center

3d•$19 - $29

About The Position

The Outpatient Physician Coding Specialist performs prospective and retrospective coding and compliance reviews of surgical procedure documentation and practitioner-assigned codes. The role audits physician evaluation and management (E/M) coding against medical-record documentation, verifies appropriate charge levels, researches coding-related claim denials, and makes corrections or appeals for resubmission. The specialist also completes coding tasks to support clean claims and helps monitor coding accuracy and compliance. The specialist meets regularly with physicians and clinical staff to assess coding knowledge, explain clinic guidelines, workflows, and software, and provide training and follow-up. Additional duties include reviewing claims that fail claim-scrubber audits, addressing patient complaints related to coding, conducting daily 24/72-hour rule checks, posting facility fees, preparing Medicare Part A claims, and processing specified hospital, cardiology, and vascular surgery charges. The role maintains knowledge of federal physician-coding and reimbursement regulations and completes other tasks as assigned by the Coding Manager.

Requirements

At least 2 years of experience working in a medical center in billing, coding, or reimbursement involving Medicare, Medicaid, and insurance.
Computer literacy, including operation of computer systems and use of software applications.
CPC must be successfully completed within 2 years of hire.

Nice To Haves

CPC, CCA, CCS, CCS-P, RHIA, or RHIT credential preferred.
Working knowledge of medical billing regulatory requirements and CPT and ICD-9 diagnosis coding, including modifiers, preferred.

Responsibilities

Perform prospective and retrospective coding reviews of surgical procedure documentation, checking procedure and diagnosis codes, place of service, modifiers, and other coding details for accuracy.
Independently interpret medical-record clinical content and sequence codes appropriately.
Audit practitioner E/M coding against medical-record documentation and confirm the appropriate charge level.
Meet with newly hired physicians to assess coding knowledge and educate them on clinic coding guidelines, workflow, and software functionality.
Meet regularly with physicians and other clinical staff to provide coding training and education, follow up on issues, and suggest improvements.
Review commercial claims that fail the claim-scrubber audit, determine the problem, and make corrections as necessary.
Research insurance and government-payer claim denials related to coding and make corrections or appeals for resubmission.
Review patient complaints referred by the Business Office that involve coding and make corrections or appeals for claim resubmission.
Identify coding issues for the Compliance Audit report, train clinical staff to address them, and conduct follow-up reviews.
Perform daily 24/72-hour rule checks, complete facility-fee posting, and prepare claims for Medicare Part A submission.
Process hospital charges for fee-for-time (locum tenens) physicians, including CPT and ICD-10 coding, appointment creation, and route sheets.
Process Cardiology special procedure and Vascular surgery charges.
Maintain knowledge of federal regulations related to physician coding and reimbursement; attend webinars, read bulletins, and participate in Coding group meetings as directed by the Coding Manager.
Maintain coding credentials through a coding society.
Complete other tasks as assigned by the Coding Manager.