Coding Spec III- Remote
MedStar Health
Remote
spec
remote
medical
health
education
billing
compliance
regulatory
training
work independently
quality standards
continuing education
community
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October 1, 2022
MedStar Health
Columbia, Maryland
FULL_TIME
- Job Summary
- Ensures that MedStar Health's medical-professional services are coded correctly and completely, based upon extensive, complete, up-to-date knowledge of regulatory and specific payer requirements. Recommends policy and a procedural change to obtain optimum reimbursement for services rendered. In addition to interacting with physicians on coding issues, ensures that physician encounter forms, the GE IDX billing system and MMG processes are up to date and compliant regarding coding issues. Assists manager as required. Mentors and reviews work of Coding Edit Specialist, Coding Specialist I and Coding Specialist II as required.
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- Minimum Qualifications
- Education/Training
- High School graduation or equivalent required. Bachelor's Degree preferred. Consideration will be given to appropriate combination of education, training and experience.
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- Experience
- 5 years medical-professional coding experience with demonstrated ability to work independently. 2 years experience leading others or leading a work stream is required. Additional years of experience strongly preferred. Experience with computer systems for encoding and abstracting.
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- License/Certification/Registration
- CPC (Certified Professional Coder) certification required.
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- Knowledge, Skills & Abilities
- Demonstrated attention to detail accompanied by outstanding organizational skills. Ability to interact effectively with physicians, liaisons, department administrators and associates. Ability to work independently and practice self-direction. Working knowledge of payer policies, CMS policies, local and national regulatory and compliance policies; regular utilization of all available coding resources. Ability to toggle between specialty coding disciplines, including ancillary services, including Anesthesia, Emergency Medicine, Radiology, Pathology and others. Verbal and written communication skills. Basic computer skills preferred.
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- Primary Duties and Responsibilities
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
- Abstracts and ensures accuracy of diagnosis, procedure, patient demographics, and other required data elements.
- Aids in the creation of training and educational coding guidance documents for physicians and MMG Associates.
- Assists in developing guidance to clinicians in optimizing dictations to promote compliance and claim processing.
- Assists in the maintenance of billing, coding and edit dictionaries in the billing system.
- Consistently meets or exceeds established Quality, Accuracy, and Productivity standards as defined by policies.
- Contacts physician when conflicting or ambiguous information appears in the medical record. Requests diagnosis from physicians when not recorded in medical records.
- Determines the sequence of diagnoses for accurate claims submission.
- Employs knowledge of coding compliance, and directs efforts to achieve quality standards identified through coding reviews or targeted by management for improvement.
- Guides and provides mentoring related to coding projects done by Coding Specialist I and Coding Specialist II to include review and correction of code selection based upon medical documentation.
- Handles complex coding case review, including but not limited to surgical coding (Orthopaedics, Cardiac, Neurosurgery, Otolaryngology, etc.) extraction, co-surgery scenarios, multivisceral transplant cases, comorbidity evaluation.
- Identifies and reports issues and trends in physician documentation and/or work routed to Coding from other departments.
- Identifies coding trends relative to edits/denials/physician feedback.
- Maintains continuing education and credentials as required for job classification.
- Provides guidance to Coding Specialists I and II related to complex edit and appeal scenarios
- Recommends policy and procedural changes and improvements for revenue enhancement.
- Surveys Medical Professional Societies coding guidelines to ensure usage of current coding combinations and rationale.
- Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
- Performs other duties as assigned.
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MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
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