What are the responsibilities and job description for the Specialty Physician Coder position at Elevait Solutions?
Specialty Physician Coder | Onsite | Fountain Valley CA
What You'll Do
What You'll Do
- Review and analyze specialty coding and billing for charge processing.
- Review and accurately code office, hospital, and surgical/procedure services for reimbursement.
- Ensure accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients.
- Work with the Coding Compliance Manager on discovered coding trends, irregularities, and needed action items.
- Achieve productivity standards as established by management, Achieve quality standards as established by management.
- Analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes according to established coding guidelines.
- Review and natively code surgical operative and/or procedure reports.
- Follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing and coding improvements.
- Participate in developing, implementing, and reviewing programs for coding compliance monitoring, benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
- Work in the Follow-Up and Claim Edit work queues and analyze denial trends for optimization opportunities.
- Provide ongoing and frequent communication and education to providers to maximize coding compliance and reimbursement.
- Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams.
- Work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues.
- Perform monthly coding change report analysis and oversight on provider coding change trends and communicate and educate providers as needed.
- Work weekly Missing Charge Reports to identify missed billable charges and maximize reimbursement.
- Organize, attend, and participate in specialty provider meetings.
- Prepare presentation materials for meetings.
- Document meeting minutes.
- Follow up on important action items and decisions from meetings and report to the Coding Compliance Manager.
- Take responsibility for various projects as assigned by management.
- Perform additional and miscellaneous duties as requested by the management team within the scope of knowledge and ability.
- Other duties as assigned.
- Required Education: High School Diploma or GED.
- Required Certifications & Licensure: AAPC – Certified Professional Coder (CPC) OR AHIMA – Certified Coding Specialist (CCS).
- Three (3) years of experience working in a hospital or physician’s office as a medical coder and interacting with physicians.
- One (1) year of experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, General Surgery, Radiation Oncology
- Proficient in Microsoft Office Suite, Proficient in Epic software.
- Excellent communication skills with the ability to communicate information accurately and clearly.
- Ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams.
- Ability to provide excellent customer service and address a moderate amount of incoming email and phone calls.
- Collaborative team player with the ability to adapt to the ever-changing healthcare environment.
- Professional demeanor at all times.
- Ability to handle complex and confidential information with discretion.
- Strong work ethic; honest and dependable.
- Strong personal time management skills.
- Expert knowledge of ICD-10, CPT, and HCPCS.
- Strong knowledge of medical terminology, anatomy, and physiology.
- English – Read, Write, Speak.
- Epic software experience.
- Specialty coding certification in a relevant specialty area, including but not limited to: AAPC – Certified Cardiology Coder (CCC); AAPC – Certified Gastroenterology Coder (CGIC); AAPC – Certified General Surgery Coder (CGSC)
- One (1) year experience as a specialty coder in one of the following specialties: Cardiology; Gastroenterology; Medical Hematology/Oncology; OBGYN; Pulmonology; General Surgery; Radiation Oncology
- Key Technical Requirements: EPIC; ICD-10 Coding; CPT Coding; HCPCS Coding; Medical Terminology; Anatomy and Physiology; Claim Denials Management; Healthcare Revenue Cycle Knowledge; Provider Education and Coding Compliance
- Works under the direction of the Coding Compliance Manager.
- Collaborates with physicians, clinical partners, business center teams, Physician Billing Services Insurance Representatives, and Customer Service Representatives.
- Responsible for maintaining confidentiality, coding accuracy, productivity standards, and quality standards.