Coding Specialist

Summary:
The Coding Specialist reports to the Manager of Physician Coding. Ensures that appropriate diagnostic and procedural codes (CPT-4 ICD-9/10 HCPCS) are submitted for professional charges resulting in accurate claims processing data retrieval and analysis.

 

Responsibilities:
Assesses the adequacy of the documentation for the provider visit or procedure which supports the diagnosis. Reviews procedure codes selected by the provider for hospital services and complex office services all diagnoses for medical necessity and adequate specificity.



Queries providers when documentation in the patient record is inadequate unclear does not support the code assigned or indicates that additional services were performed that were not coded. With provider consent corrects and revises codes as necessary to ensure compliance with federal law and payer guidelines and requirements and to ensure optimal reimbursement.



Refers coding billing and system questions to the Manager after exhausting own efforts to answer them by referencing appropriate coding publications and other resources.



Performs audits of provider coding and documentation as required and educates providers regarding improvement in both.



Remains current with coding guidelines and documentation requirements.



Maintains coding certification by earning required continuing education units.



Performs other related duties as assigned.

 

Other information:
BASIC KNOWLEDGE:

High school diploma or equivalent.



Successful completion of formal education in medical coding.



Certification from the American Academy of Professional Coders (AAPC) American Health Information Management Association (AHIMA) or other association required.



EXPERIENCE:

One year medical billing experience in a hospital medical office or billing company or the equivalent.



Coding experience preferred.



Training in anatomy physiology and disease processes preferred.



Ability to analyze patient record and to recognize and analyze clinical documentation pertinent for coding.



Writing skills sufficient to prepare physician queries.



Computer skills to research internet websites to clarify diseases or procedures and to access payer policies.



Ability to use computer applications including Excel Word Adobe Reader Microsoft Outlook and third party payer websites.



Previous Epic experience a plus.



A normal office environment.

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Corporate Headquarters USA:RI:Providence

 

Work Type: Full Time

 

Shift: 1

 

Union: Non-Union


Work Schedule M-F 8 AM -4:30 PM