The Coding Specialist II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.The PB Coding Specialist II performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on more complex encounters and/or has expertise with HCPCs procedural codes. This position has deep understanding of disease process, A&P and pharmacology and acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service. This position trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function. The Coding Specialist II also demonstrates expertise to resolve Optum coding edits.Responsibilities:Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and Management services, bedside procedures and diagnostic tests as needed.Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports)Provides documentation feedback to physiciansMaintains coding reference informationTrains physicians and other staff regarding documentation, billing and coding.Reviews and communicates new or revised billing and coding guidelines and informationAttends meetings and educational roundtables, communicates pertinent information to physicians and staff.Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appealsActs as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.Meets established minimum coding productivity and quality standards for each encounter typeMay perform other duties as assigned.
