Provider Coding Specialist

Provider Coding Specialist role at Tidelands Health

Employee Type:
Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Under the supervision of the Coding Supervisor, the Provider Coding Specialist analyzes and assigns ICD-10-CM diagnostic codes, CPT, and HCPCS codes to professional surgical patient accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Organization policy and procedure. They abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC.

Responsibilities include abstracting required clinical information from the medical record, querying physicians to clarify documentation for accurate code assignment, organizing and prioritizing work to meet deadlines and goals, maintaining and expanding knowledge of coding and sequencing guidelines, and resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement and a clean claim rate.

• Analyze medical records, interpret documentation, and assign proper ICD‑10‑CM, CPT/HCPCS, and modifiers utilizing designated software, coding manuals and other reference material as required.
• Enter charges for procedures that are not soft coded as instructed for certain patient types.
• Consistently meet coding quality and productivity standards established by the coding department.
• Work closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions, assisting with coding inquiries from billing and administrative staff to ensure accurate codes for reimbursement.
• Gather and verify all information required to produce a clean claim, including special billing procedures defined by a payer or contract.
• Review and resolve clearinghouse rejection errors, denials, and charge review/claim edits daily; also review accounts returned from various departments and process corrections for clean claim submission.
• Collaborate with the Compliance/Quality Team on coding quality issues identified via internal or external reviews, implementing accurate coding quality recommendations.
• Work with HIM operations as needed to clarify query and documentation needs; query providers to clarify incomplete or ambiguous documentation and follow up for timely resolution.
• Review and code Orthopedic, OB/GYN, and other surgical specialties procedures with minimal supervision, ensuring correct coding and sequencing of diagnoses and procedures.
• Provide continuous education and feedback to surgeons and clinical staff regarding ICD‑10 coding and documentation best practices for surgical procedures.

• High School Diploma Required

• 2+ years of abstract coding for physician services Required.
• Minimum of four years of healthcare experience, with at least three years of professional coding experience in Orthopedics or OB/GYN Required.
• Experience working remotely Preferred.

• Basic knowledge of ICD‑10‑CM diagnostic and CPT/HCPCS procedure codes principles and guidelines.
• Basic knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and metric systems.
• Basic knowledge of Standards of Ethical Coding.
• Skills and ability to communicate effectively both orally and in writing.
• Skills and ability to maintain working relationships with physicians and other staff.
• Skills and ability to review the work of others and maintain confidentiality.
• Knowledge of Microsoft Applications including Excel, Word, PowerPoint, Outlook, etc.
• Strong analytical capabilities.
• Strong organizational skills.
• Advanced ability to function independently and be a self‑starter.
• Outstanding research skills and ability to use independent judgment to solve problems.
• Handle multiple priorities.
• Listen and acknowledge ideas and expressions of others attentively.
• Converse clearly using appropriate verbal and body language.
• Collaborate with others to achieve a common goal through cooperation.
• Influence…