Clinical Code Specialist
4 days ago
Medical Coding Specialist Role
We are seeking a detail-oriented and analytical medical coding specialist to join our team. The ideal candidate will have expertise in clinical coding, coding guidelines, and claims processing.
- Review and analyze claims denied due to coding-related issues, including diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), and related modifiers.
- Identify coding discrepancies, documentation deficiencies, and other factors contributing to claims denials, utilizing a thorough understanding of coding guidelines, industry standards, and regulatory requirements.
- Collaborate with coding teams, healthcare providers, and revenue cycle stakeholders to obtain necessary documentation and information for claims resubmission.
- Conduct in-depth coding audits and analysis to validate the accuracy, completeness, and compliance of coding practices, and ensure alignment with payer requirements.
- Research and interpret coding guidelines, including updates from coding authorities, to ensure coding accuracy and compliance.
- Work closely with coding staff and providers to address and resolve coding-related issues, provide education on coding best practices, and improve coding performance.
- Maintain up-to-date knowledge of payer policies, medical necessity criteria, and reimbursement guidelines to accurately evaluate coding denials and appeals.
- Compile and prepare detailed reports on coding-related denials, identifying patterns, trends, and opportunities for process improvement.
- Collaborate with the revenue cycle team to develop strategies and initiatives aimed at reducing coding-related denials and improving overall revenue cycle performance.
- Stay informed about emerging coding trends, changes in coding guidelines, and industry best practices, and provide recommendations for updating coding processes and policies.
- Participate in coding-related meetings, committees, and training sessions to share insights, contribute to problem-solving, and promote cross-departmental collaboration.
Qualifications:
- Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or similar certification is required.
- Experience: Minimum of 2-3 years of medical coding or auditing experience and experience with risk adjustment audits, clinical documentation improvement (CDI), and payer audits.
- Knowledge of Coding Systems: Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and familiarity with DRG, E/M coding.
- Bachelor's degree: in Nursing, or any Medical or Health Information Management or a related field.
- Familiarity with medical necessity criteria, payer policies, and reimbursement methodologies.
- Excellent understanding of revenue cycle processes, claims processing workflows, and denials management.
- Proficiency in using coding software, encoders, and electronic health record (EHR) systems.
- Detail-oriented mindset with a high level of accuracy and organizational skills.
- Effective communication and interpersonal skills to collaborate with coding teams, providers, and other stakeholders.
- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
- Proficiency in using coding-related software and tools, as well as a high level of computer literacy.
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