In this role you will:The Coding Specialist works with surgeons, other coders, and insurance carriers; performs occasional abstract coding, resolves claim issues and participates in denial management. Additionally, Coding Specialists:
- Follow Orthopaedic Solutions Management policy and procedures along with applying federal and state guidelines to coding efforts.
- Interprets and follows up on Explanation of Benefits.
- Performs timely review of accounts by monitoring the account activity and providing adequate follow-up to ensure maximum reimbursement is received.
- Maintains Quantity & Quality of assigned work.
Key Responsibilities
- Determine the proper codes and modifiers for all billable services utilizing ICD10 CM and CPT as well as HCPCS or payor specific guidelines.
- Code for 100% of medical records/encounters for each assigned clinic or encounter type when available
- Identify and analyze problems or issues
- Abstract Codes from Medical Documentation
- Knowledge of Spine Codes
- Takes appropriate actions on denied charges to ensure claims are paid on the first follow-up or appeal.
- Works with assigned queues, aging and denial reports to accomplish the set goal for the position.
- Responsible for learning, understanding, and following Payor guidelines.
- Notifying management of payer policy coding changes.
- Ensuring appropriate information is submitted to insurance companies in order to expedite payment.
- Works to understand the operative notes that dictate procedures billed.
- Work special assignments when needed.
- Utilizes the coding resources (CPT, ICD-10, CDR, AAOS books, Select Coder) to understand procedures that are denied.
- Documents accounts correctly.
- Ensures compliance with all company plans, policies and procedures set forth by Florida Orthopaedic Institute.
- All other duties as assigned.
About You:
- Minimum of five (5) year's health care coding experience with ICD-10-CM, PCS, CPT and DRG classification systems - with a thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement for multiple medical specialties. *
- Minimum of two (2) years health care coding experience specifically with spine.
- Coding Certification: CCS, CCS-P, CPC, CPC-H, CCA, COC, RHIT, RHIA, or NRCCS
- High school diploma or general education degree (GED).
- Knowledge of medical terminology & medical coding. Insurance collection and denial process experience (minimum of 5 years)
- Knowledge of computer skills (Microsoft Office Suite, general EMR knowledge, payor website).
- Experience with automated patient care and coding systems. (Athena, FileMaker, Incisions) Select Coder Assisted Coding encoder.
*Required certifications are as follows:Certified Professional Coder ( CPC ), Certified Professional Coder- Hospital ( CPC-H ), Certified Coding Specialist ( CCS ), Certified Coding Specialist - Physician-based ( CCSP ) Certification, Radiation Oncology Certification Coder ( ROCC ), Certified Interventional Radiology Coder ( CIRCC ),OR Any certification sponsored by the American Academy of Professional Coders ( AAPC ), Registered Health Information Technician ( RHIT ), or Registered Health Information Administrator ( RHIA ). Other accredited coding certifications may be considered.We Would Love It If You Also Had:
- Knowledge of ICD10, CPT HCPCS and the use of modifiers
- Surgical coding experience
- Familiar with CMS 1500 completion
- Athena experience
- Previous coding experience, preferably specializing in Spine.
- An active coding certification.
At FOI our goal is to provide our patients with world-class orthopedic care.Our mission of providing the best care encompasses not only the care the physician provides, but all medical and administrative aspects of the patients encounter with Florida Orthopaedic Institute (FOI) as well. Every staff member plays a vital role in this mission. We take pride in receiving the Patriot Award from the Department of Defense for the support that we give to National Guard and Reserve members who are employed by FOI. We are committed to encouraging a culture of inclusion reflective of the communities we serve, and we provide equal opportunity to all. Florida Orthopaedic Institute conforms to the spirit as well as to the letter of all applicable laws and regulations.What we offer:
- Full-time remote opportunities available, with room for career growth and advancement.
- Excellent job security and stability, to promote an optimal work life balance.
- Be part of this dynamic and growing high level Coding Team!