Revenue Cycle Certified Coder

Orthopedic Specialists of Northwest Indiana, LLC•St. John, IN

16h

About The Position

The Coding Specialist reviews superbills and the corresponding medical record documentation and assigns appropriate CPT, HCPCS, modifiers, and ICD 10 codes and post charges in order to achieve maximum reimbursement in accordance with OSNI protocols and procedures along with CMS and private payer guidelines. The core responsibilities will include: daily charge posting after assignment of appropriate billing and diagnostic codes, review of first level rejected claims in practice management, use of hospital portals to obtain operative reports and patient demographics, scanning of completed work into SRS . Additional responsibilities include querying physicians and ancillary medical staff when medical record requires clarification, ensuring medical record is amended by provider when appropriate and participating in internal provider coding review sessions.

Requirements

High school diploma or an equivalent combination of education and experience.
RHIT, CPC, or CCS is required.
Data entry skills (50-60 keystrokes per minutes)
Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing coding or billing functions is required.
Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc), managed care contracts and coordination of benefits is required.
Thorough working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are required.
Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers.
Accuracy, attentiveness to detail and time management skills are required.

Nice To Haves

Associate degree or higher in coding or health information management, accounting or business administration highly desired.

Responsibilities

Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions.
Performs all coding functions, including CPT/HCPCS and ICD 10 code assignment in accordance with state, federal, and payer guidelines:
Reviews medical record to ensure appropriate codes are utilized and documentation supports code use
Assigns appropriate CPT, HCPCS, ICD-10 codes along with appropriate modifiers to capture service rendered
Queries physicians and medical ancillary staff when necessary for clarification.
These functions will be in coordination with the Business Office team.
Performs accurate charge data entry into practice management system
Reports missing data as required
Participates in internal provider coding review sessions
Reviews and corrects electronic first level claim rejections in practice management
Prints and mails paper claims with corresponding records as appropriate
Follows applicable coding guidelines and legal requirements to ensure compliance with federal and state regulations
Maintains thorough working knowledge of private payer guidelines
Remains apprised of changes to coding guidelines and code sets
Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff, as required to clarify discrepancies, and obtain demographic and clinical information.
May prepare special reports as directed by the Manager to document coding
May serve as relief support, if the work schedule or workload demands assistance to departmental personnel.
May also be chosen to serve as a resource to train new employees.
Cross- training in various functions is expected to assist in the smooth delivery of departmental services.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, as well as OSNI’s Standards of Conduct, and other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Other duties as needed and assigned by Billing Manager, Practice Manager, and/or CEO