The Coding Specialist II reports to the Director of Reimbursement and is responsible for correct coding of professional services and upholding compliance standards in the Orthopedics Department.
- Perform coding and related duties using established Orthopedic Coding Department policies in an accurate and timely manner. Review medical documentation and encounter forms and assign CPT, ICD-9, HCPCS II and modifiers based on documentation and payer requirements.
- File multi-level appeals with insurance companies in tandem with Billing Office Follow-up Representatives
- Understand and utilize key coding tools (Code-X, EPIC, Outlook, Excel, and Word) to improve the quality of the final coding product.
- Other duties as assigned.
- Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct, and report coding problems.
- Maintain adequate knowledge of coding, compliance and reimbursement procedures. Review current literature, newsletters, payer policy updates, and coding manuals. Disseminate coding related updates to Physicians, Co-workers, and Senior Management within the Department
- Function as a resource to Coding Specialists, Ortho Billing Office staff, Physicians, and external customers. Research and resolve all coding inquiries. Facilitate coding education for Physician and co-workers.
- Make recommendations for coding policy changes. Participate in the encounter form revision process to ensure correct coding standards are met.
- Develop and maintain division specific coding procedures.
- Complete special projects as assigned by management which require defining problems, determining work sequences, summarizing findings, and implementing required changes.
- Performs quality assurance reviews of Coding Specialists and peer reviews with fellow Coding Specialists II depending on area(s) of expertise.
- Maintain coding certification(s).
- Resolve coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
- High school diploma required
- Coding certification required CPC or CCS-P.
- Specify minimum education and clearly indicate if preferred or required
- Five consecutive years progressively responsible experience as described above is required.
- Must hold a coding certification (CPC or CCS-P) for five consecutive years.
Vacancy Type: Full Time
Job Location: Boston, MA, US
Application Deadline: N/A