Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Responsible for developing coding and billing change procedures. Responsible for training on all coding and billing changes.
Specific Duties & Responsibilities
Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
Works closely with Office of Billing Quality Assurance to include review of documentation.
Serves as departmental expert on coding questions.
Exercises independent judgment and decision making on a regular basis with respect to code selection.
Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies.
Researches and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
Review and resolve Epic Charge Review Edits daily.
May act as a back up to Charge Entry when needed.
Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.
Works with Department Management to create Charge Review Rules to prevent unnecessary denials.
Works with Department Management on maintenance of provider preference lists.
Provides training on all coding changes to providers and staff. Develops presentations to effectively communicate how changes will affect provider billing and coding. Provide face to face training on changes to providers based at all Hopkins locations.
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of JHU/ PBS Billing Applications.
Utilize online resources to facilitate efficient claims processing.
Capable of advance problem solving in medical billing and coding.
Professional & Personal Development:
Participate in on-going educational activities.
Assist in the training of staff, providers, management and administration.
Complete three days of training annually.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
Supervision of Others:
May assist in directing the activities of coding staff or a function relating to the training of new coding staff in coding applications.
High School Diploma/GED.
Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge.
Sub specialty coding certification or second AAPC certification in the departmental area of expertise.
(Internal Candidates only – when a sub specialty coding certification or second AAPC certification is not available in clinical specialization, additional years of experience may be considered in lieu of second certification at the discretion of department management.)
Minimum five years coding experience with demonstrated analytical skills.
Experience with Medicare regulations.
Understanding of third party payer issues.
Excellent written and oral communication skills with the ability to communicate effectively with clinic staff, providers, bill staff, management and administration.
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
Special Knowledge, Skills, and Abilities
Able to sit in a normal seated position for extended periods of time.
Able to reach by extending hand(s) or arm(s) in any direction.
Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.
Able to communicate using the spoken and written word.
Able to see within normal parameters and to hear within normal range.
Able to move about.
Able to lift minimum weight, 10 lbs.
Classified Title: Coding Specialist III Working Title: Coding Specialist III Role/Level/Range: ATO 40/E/03/OG Starting Salary Range: $46,987 - $64,657; Commensurate with experience Employee group: Full Time Schedule: Monday-Friday, 8:30am-5:00pm, Up to 40 hrs/ week Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10003152-SOM Rad Onc Clinical Faculty and Staff Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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