Coding Specialist II

Palomar Health Medical Group

1d

About The Position

Under general supervision, the Coding Specialist II is responsible for proper application of coding guidelines and principals for primary care and specialty physicians. Reviews documentation and enters appropriate CPT/ICD-10 codes, assess accuracy, and ensures optimal reimbursement. Additional duties include but are not limited to insurance verification, code reviews, and auditing accounts.

Processes incoming pending charges/superbills, processing office charges within 48 hours and communicates possible problems to departments and business office manager. Reviews and validates or abstracts and processes surgery charges for a minimum of one specialty within 72 hours of receipt. Understands and adheres to the insurance carrier's claim submission and appeal process. Makes necessary corrections to patient accounts and charges for accurate electronic submission. Prioritizes daily workload to best increase reimbursement and decrease A/R days. Reviews and corrects any errors or missing information on electronic claims, attaches necessary documentation for payment if required. Keeps abreast of coding and reimbursement changes. Demonstrates and promotes a spirit of teamwork and cooperation. Uses initiative to improve skills, learn new skills, enhance knowledge, and improve communications. Tracks and reports ongoing issues with coding and documentation as discovered. Supports processing of incoming pending charges/superbills for primary care physicians. Performs other duties as assigned.

Requirements

• Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position
• Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail)
• Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the first two weeks of employment to perform the essential functions of the job
• Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards
• Carries out the mission, vision, and quality commitment of Palomar Health Medical Group
• High School Diploma or equivalent
• 2 years (non-specialty) coding experience, including abstracting, in outpatient setting
• CPC (Certified Professional Coder) credentialing plus one specialty. In lieu of the specialty certification, 4 years (non-specialty) coding experience, including abstracting, in outpatient setting, with 2 or more years specialty coding is required

Nice To Haves

• College level courses or associate degree
• 1 or more years in specialty coding
• Certification in Specialty area of practice or role

Responsibilities

• Proper application of coding guidelines and principals for primary care and specialty physicians
• Reviews documentation and enters appropriate CPT/ICD-10 codes, assess accuracy, and ensures optimal reimbursement
• Insurance verification, code reviews, and auditing accounts
• Processes incoming pending charges/superbills, processing office charges within 48 hours and communicates possible problems to departments and business office manager
• Reviews and validates or abstracts and processes surgery charges for a minimum of one specialty within 72 hours of receipt
• Understands and adheres to the insurance carrier's claim submission and appeal process
• Makes necessary corrections to patient accounts and charges for accurate electronic submission
• Prioritizes daily workload to best increase reimbursement and decrease A/R days
• Reviews and corrects any errors or missing information on electronic claims, attaches necessary documentation for payment if required
• Keeps abreast of coding and reimbursement changes
• Demonstrates and promotes a spirit of teamwork and cooperation
• Uses initiative to improve skills, learn new skills, enhance knowledge, and improve communications
• Tracks and reports ongoing issues with coding and documentation as discovered
• Supports processing of incoming pending charges/superbills for primary care physicians
• Performs other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED