Coding Reimbursement Specialist III – Post Claim Denials

Essential Functions

• Subject matter expert in at least one specialty, e.g., oncology, gynecology, surgical coding (not including primary care procedures) and infusion coding including chemotherapy and infusions involving multiple drugs.
• Assigns CPT and ICD codes in cases of moderate to high complexity.
• Reads, interprets and assigns CPT codes from provider documentation, e.g., infusion record or operative report.
• Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered.
• Appends all modifiers.
• Ranks CPT codes when multiple codes apply.
• Assigns Evaluation and Management (E/M) codes.
• Performs reconciliation process to ensure all charges are captured.
• Processes automated or manually enters charges into applicable billing system.
• Researches and analyzes coding and payer specific issues.
• Processes charges on a timely basis and communicates with team members and practice management on an ongoing basis.
• Communicates with providers related to coding issues that are of moderate to high complexity. Including face to face interaction, explaining coding rationales, and education with providers.

Education, Experience and Certifications

• High School Diploma or GED required.
• Minimum of 2 years of coding experience required.
• CPC or equivalent coding credential required. Maintain coding certification (CPC, CCS, RHIT, RHIA).
• Extensive knowledge of coding, medical terminology, anatomy, and physiology. Extensive knowledge of and the ability to apply the payer specific rules regarding coding, bundling, and adding appropriate modifiers.

Physical Requirements

• Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending.

Aurora Health Care