Coding Quality Specialist 3 - Urology
- Charlottesville, VA
- $23.29-37.26 per hour
- Permanent
- Full-time
- Reviews documentation in medical record to appropriately assign ICD-10-CM, CPT-4, HCPCS and modifiers within a timely manner to capture all services rendered by providers at all locations. Encounters may be within Epic, outside electronic medical record systems, or based on paper documentation.
- Monitors, analyzes, and resolves charge review, claim edit, and coding-related denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.
- Reviews and resolves charge sessions that fail charge review edits, claim edits and follow-up work queues, identifies areas of opportunity based on findings/resolution of errors.
- Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.
- Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to coding leadership and/or provider education team.
- Assists coding staff, physicians, and other health care practitioners with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to leaders.
- Ensures all coded services meet appropriate governmental regulations and guidelines, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
- Utilizes available resources for assignment of codes as necessary (e.g., Diagnostic Imaging system, Lab system, Emergency, Epic, and coding reference software and/or books).
- Trains and mentors Coding Quality Specialists to effectively perform their job responsibilities following current coding policies and procedures at the discretion of coding leadership
- Assists coders with medical terminology, disease processes and surgical techniques.
- Assists other coders in resolving coding issues/questions.
- Performs peer review as directed from coding leadership.
- Queries physicians to obtain clarification or missing elements in the record preventing correct coding.
- Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims.
- Completes special projects as directed by coding leadership.
- Performs charge corrections when appropriate.
- Performs other duties as assigned.