Coder - Medical Coder - Coding Analyst

SUMMARY The Coding Support Analyst is responsible for supporting the coding/documentation needs of our providers and Regional Business Office staff. 



ESSENTIAL DUTIES AND RESPONSIBILITIES

 

·  Conduct provider documentation audits for all providers within a designated area

·  Coordinate the data retrieval and analysis of clinical documentation associated with focused provider audits

·  Compile and maintain audit results.

·  Compile monthly coding utilization and financial reports including summary reports for all providers.

·  Develop/maintain effective feedback/communication with providers re: documentation and coding

·  Participate in provider meetings related to coding and reimbursement issues.

·  Participate clinic staff meetings, when necessary

·  Work closely with clinic operations and clinical staff regarding coding, documentation and/or billing processes

·  Support Regional Billing Office staff when coding and/or reimbursement related questions / issues arise

·  Assist RBO in the appeal of denied or low paid claims by analyzing appeal data, clinical documentation and/or industry references, as necessary.

·  Research and respond to payer and/or patient inquiries related to coding.

·  Review and maintain charge master and diagnosis master files ensuring that current and accurate codes exist.

·  Review, update and maintain fee tickets used for charge capture

·  Communicate with third-party payers, when necessary, regarding coding / documentation and/or appeals.

·  Assist in the development and maintenance of coding and/or reimbursement policies and/or procedures as well as training materials, as needed.

·  Maintain inventory of all Coding and Documentation training materials utilized

·  Conduct training for providers, clinic and RBO coding staff related to coding and documentation.

·  Maintain training logs

·  Other duties as assigned.

 

KNOWLEDGE, SKILLS AND ABILITIES

 

·  Working knowledge of ICD-9, CPT and HCPCS coding nomenclature; fee schedule reimbursement methodology; and regulatory requirements for physician coding and reimbursement.

·  Working knowledge of key coding concepts such as use of CPT modifiers; surgical package definitions, medical record documentation requirements; and multiple procedure guidelines.

·  Prior physician coding / documentation training preferred.

·  Computer skills for practical purposes.  Working knowledge of Word and Excel required. 

·  Skill and proficiency in internet search functionality is required.

·  Prior formal training or a working understanding of basic Medical Terminology as well as Anatomy and Physiology.

·  General understanding of professional fee billing processes and/procedures.

 

EDUCATION

 

High School diploma or equivalency.  College degree preferred.

 

EXPERIENCE

 

Minimum of five years coding and/or physician reimbursement experience.  Workers’ Compensation industry knowledge preferred.

 

LICENSE/CERTIFICATION

 

CPC or other coding certification preferred.