Coding Specialist II - Pathology Job Listing at MedStar Health in United States of America (Job ID 159814)

Description

About the Job

MedStar Health is seeking a Coding Specialist II with experience in pathology coding to join our coding team.

To qualify for a Level II Coding Specialist role, candidates must have 3–4 years of medical professional coding experience and hold a current CPC certification. We are specifically looking for individuals with pathology coding experience, including working pre-bill claim scrubber edits and managing coding-related insurance rejections.

The selected candidate will enjoy a remote, full-time, day-shift schedule.

General Summary of Position - 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 are in the GE IDX billing system and MPBS processes are up to date and compliant regarding coding issues. Assists manager as required. Mentors and reviews work of Coding Edit Specialists and Coding Specialist I as required.

Primary Duties and Responsibilities

• Abstracts and ensures accuracy of diagnosis procedure patient demographics and other required data elements.
• Accesses and understands coding software used by hospital coders as a verification/cross check tool to ensure that technical component coding done by hospital coders and professional component coding is synchronized correctly on accounts involving both billing components (example: Radiology coding).
• Aids in the creation of training and educational coding guidance documents for physicians and MPBS MedStar Associates.
• 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 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 Edit Specialist to include review and correction of code selection based upon medical documentation.
• Identifies and reports issues and trends in physician documentation and/or work routed to Coding from other departments.
• Maintains continuing education and credentials as required for job classification.
• Recommends policy and procedural changes and improvements for revenue enhancement.
• 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.
• 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.

Minimal Qualifications
Education

• High School Diploma or GED required 
• Bachelor's degree preferred 
• Consideration will be given to appropriate combination of education, training and experience. 

Experience

• 3-4 years Medical-professional coding experience with demonstrated ability to work independently. Experience with computer systems for encoding and abstracting required 
• 1-2 years Leading others or leading a work stream

Licenses and Certifications

• CPC (Certified Professional Coder) certification required

Knowledge Skills and Abilities

• 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.
• Ability to communicate and deal with physicians in a professional articulate manner and understand medical terminology specific to body systems.
• In-depth knowledge of billing process including but not limited to claims submission whether manual or electronic different payer requirements re: modifiers and correct diagnosis/procedure linkage.
• Broad deep medical knowledge including but not limited to: extensive knowledge of medical terminology, knowledge of human anatomical systems/body systems and knowledge of medical procedures performed by physicians, nurses and allied health workers.
• Working knowledge of payer policies HCFA policies local and national regulatory and compliance policy knowledge of all available coding resources.
• Basic computer skills preferred.