BH Coding Specialist II

GENERAL SUMMARY:

Responsible for accurate and compliant assignment of CPT and ICD 10 codes supported by provider documentation in the medical record utilizing the current year International Classification of Diseases Manual (ICD-10) and the current year American Medical Association’s Current Procedural Terminology manual (CPT) ensuring optimal reimbursement. \

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.
2. *Accurately assigns and sequences diagnosis and procedure codes to arrive at the correct Ambulatory Payment Classification assignment - utilizing provider supporting documentation.
3. *Maintains thorough understanding of Government and commercial payer documentation, coding and reimbursement guidelines, CCI edits, MUE’s, NCD’s and LCD’s.
4. *Analyzes, researches and performs payer follow up tasks specific to coding denials (including but not limited to bundling/medical necessity/non-adherence to payer coding and reimbursement guidelines).
5. *Provides timely feedback to providers when identifying documentation concerns or inaccurate assignment of procedure codes.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Certification as a Certified Coding Associate (CCA) required. Certification as a Certified Coding Specialist (CCS or CCS-P) or Certified Professional Coder (CPC) preferred. Minimum of five (5) years coding experience in a medical environment required. Cardiology/Cardiothoracic/Vascular coding experience preferred.