Coding Specialist - Holds & Denials CPC at Caduceus Inc – Jersey City, New Jersey

Position Overview:

Coding Specialists are responsible to provide quality review and analysis of a wide range of patient medical records and ensure accuracy of coding and maintain records in accordance with accepted medical and legal standards. Responsible for reviewing medical records to assure proper billing of the medical record, comparison of physician chosen CPT and ICD-10 codes to the physician’s documentation to substantiate the level of coding, physician services to include identification of professional services in and complete review of medical records to accurately optimize all professional services documented for billing.

Essential Functions:

• Assign ICD-10-CM and CPT codes with modifiers for services provided in the professional fee environment.
• Review the medical records and all applicable documentation to determine the appropriate codes to assign for the services and diagnoses.
• Ensure diagnosis codes meet the local and national medical necessity guidelines.
• Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all assigned services.
• Follow all HIPPA regulations and uphold a higher standard around privacy requirements.
• Review and resolve coding edits and denials. Assists with rebilling claims when necessary.
• Maintain a working knowledge of various laws, regulations and industry guidance that impact compliant coding.
• Must meet all coder productivity and quality goals.
• Identifies issues and patterns related to coding.
• Participates in ongoing mandatory compliance training.
• Participates in monthly departmental meetings.
• Strong critical thinking skills with an ability to apply creative approaches to complicated questions.
• Other assigned duties/tasks

PREFERED SKILLS & EXPERIENCE

• Must have an AAPC CPC certification.
• Knowledge of CPT, ICD-10, and medical terminology anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to read and interpret medical procedures and terminology.
• Ability to exercise independent judgment.
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
• Ability to maintain confidentiality.
• Experience working in a medical billing environment where compliance with protected health information and HIPAA compliance is strongly enforced.
• Demonstrate proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams
• Experience level: 5+ years.

Work environment:

• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds non-routinely.
• Ability to sit for extended periods.
• Extended periods of computer usage
• Handling – seizing, holding, grasping, and fingering of objects, tools, and controls.
• Vision – close vision
• Hearing- the ability to receive detailed information through oral and telephonic communication.