Description

Essential functions

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

·        Accurate coding of patient encounters.

·        Analyze patient medical records, encounters and other documents to assign correct diagnosis (ICD-10), procedure (CPT), and supply (HCPCS) codes as necessary with a high level of accuracy.

·        Collaborate with RCM Billing Specialists to ensure that claims are managed from charge entry to claims submission with and end goal of minimizing denials and delays.

·        Talk with patients about their Slocum clinic or ASC medical bill, via phone, in person or patient portal.

·        Analyze denied claims resulting from coding errors by identifying the root cause and provide the corrected codes to the billing team for the purpose of appealing or resubmitting a corrected claim.

·        Ensure all coding conforms to CMS, AAPC, state, federal, and payer-specific guidelines.

·        Query physicians and all providers to clarify missing or ambiguous documentation to support coding accuracy.

·        Work with the RCM Coding Supervisor to evaluate charge capture processes and identify trends in denials or revenue leakage.

·        Communicate cross-functionally with providers and other Slocum departments regarding patient questions or coding concerns.

·        Perform other duties as assigned.

Requirements

·        Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar certification from AAPC or AHIMA. 

·        Strong knowledge of medical coding (ICD-10, CPT), terminology, and insurance regulations

·        2 – 4 years of medical coding experience, specifically with a revenue cycle setting.

·        2 – 4 years of healthcare experience.

·        Proficiency in medical billing software / Electronic Health Records (NextGen preferred).

·        Be able to read and understand digital and paper insurance Explanation of Benefits.

·        Strong attention to detail (Accuracy in code selection is critical for compliance and reimbursement.

·        Ability to analyze data trends to improve RCM denials resulted from coding errors.

·        Possess the ability to prioritize workload daily, weekly and monthly.

·        Show a high level of accuracy and efficiency when coding encounters.

·        Communicate clearly, concisely and courteously via phone, email and in person

Supervisory responsibilities

·        None

Physical demands

·        Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

·        Able to sit or stand for long periods of time.

·        Be able to work on a computer and keyboard for up to eight hours a day.

·        Able to walk, and use hands to finger, handle, or feel.  Able to reach with hands and arms.

·        Ability to hear and understand in person and over the phone.

·        Able to speak and provide information in person and over the phone.  

Travel required

·        None

OSHA Occupational Exposure

·       This position is designated as a Category 3 employee that does not perform tasks that involve exposure to blood, body fluids, or tissue. 

Education and Experience

·        Medical insurance knowledge and background required.

·        High school diploma or GED or equivalent experience and training required. 

·        Previous experience as an RCM Billing Specialist or related experience with patient billing, collections, and/or coding.

·        Previous experience working with Electronic Health Records.

Summary

The RCM Coding Specialist is responsible for optimizing healthcare reimbursement by translating medical encounters, documentation, and records into accurate ICD-10, CPT, and HCPCS codes.  Effective management of the billing cycle from charge capture to denial management to ensure compliance and maximize revenue is highly essential in this role.