Coding Reimbursement Specialist II

Coding Reimbursement Specialist II

The Coding Reimbursement Specialist II performs various duties to accurately interpret and bill physician charges for physician services by entering into the appropriate CPT, ICD-10, and modifiers into the Billing system.

(This is a full-time hybrid or remote position that will support the RCM team, Monday to Friday 8 am to 5 pm)

Primary Job Responsibilities/Tasks may include, but not limited to

• Performs initial charge review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers.
• Interprets progress notes, operative reports, discharge summaries, and charge documents to determine services provided and accurately assign CPT and ICD-10 coding to these services, according to guidelines established by the AMA.
• Enter appropriate data into the TMP billing system by selecting the appropriate codes, diagnosis, modifiers, to complete the charge process.
• Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met.
• Contacts physicians through query protocols regarding procedures and other services billed to ensure proper coding.
• Responsible for reviewing patient logs and other report of clinical activity to ensure billing is captured for all patients.
• Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.
• Works in conjunction with the Reimbursement staff to answer all inquiries regarding coding and billing for TMP physicians’ services.
• Performs other related duties as required and assigned.

Requirements

Education and Certifications

• High school diploma or GED completion is required.
• A minimum of three (3) years’ experience with CPT and ICD-10 coding of physician services required.
• Coding certification required. CPC Certification preferred. Must maintain active certification and required CEUs during employment tenure.
• Advanced working knowledge of medical terminology, anatomy, and physiology required.
• Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers.
• Understanding of and familiarity with regulatory guidelines including NCDs and LCDs.

Experience

• Family Practice, Internal Medicine, Cardiology, Rheumatology, Endocrinology, Gynecology, and Dermatology preferred.
• Knowledge of current third-party billing and collection regulatory guidelines and requirements.
• Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions.
• Advanced knowledge of, but not limited to, Official Coding Guidelines and methodologies.
• Knowledge of current third-party billing and collection regulatory guidelines and requirements.
• Good interpersonal skills and a basic understanding of team concept.
• Ability to gather and interpret clinical data.
• Ability to work independently in a fast-paced environment.

Physical Requirements

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.
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