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Coding Specialist

If you are interested in this position, please submit your resume on Indeed.com or by clicking here: Coding Specialist

Basic Function and Scope of Responsibilities:

This job is responsible for daily review, coding, and billing of insurance claims, follow-up on unpaid claims and insurance denial management.

Principal Responsibilities:

  • Completes charge audits
  • Communicates effectively over the phone and through written correspondence to clinic staff to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
  • Accurate data entry of charges and knowledge of medical coding
  • Review and pre-audit charge billing report to assure all required billing information has been accurately received.
  • Reviews medical records to ensure coding accuracy as needed.
  • Teamwork with other coders and billers to ensure charges are entered timely and accurately.
  • Provide training with other employees as requested by management.
  • Resolve coding errors identified by Advanced Claim Edits.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Education Requirements:

  • High School Diploma or GED equivalent required
  • Previous experience in charge-entry and or coding is preferred
  • Certified Professional Coder preferred

Performance Requirements:

Knowledge:

  • Knowledge of health insurance programs, coverage offered and third-party reimbursement mechanisms.
  • Knowledge of electronic medical record system.
  • Knowledge of manual and electronic billing systems and procedure.
  • Knowledge of eligibility, benefits and authorizations processes.
  • Detailed knowledge of billing, HCPCS, CPT and ICD-10 codes.
  • Familiarity with medical terminology.
  • Evaluates and understands contractual language and health plan payment policies as it relates to payment, compliance, reimbursement methodologies, and appeals processes.
  • Knowledge of all coding applications relevant to Oncology/Hematology/Infusion coding

Skills and Abilities:

  • Skills in operating personal computer utilizing word processing, spreadsheets, databases, email and other office equipment.
  • Strong Excel, Word, and Power Point skills.
  • Effective communication with peers, supervisors, and patients.
  • Ability to handle stressful situations.
  • Ability to meet deadlines
  • Must be detail oriented with excellent verbal and written communication skills, organizational skills, and time management skills.
  • Must possess high degree of professionalism and adaptability.
  • Skill in negotiating issues and resolving problems.
  • Exceptional multi-tasking, organizational skills and superb attention to detail.
  • Strong analytical skills.

Organizational Structure:
Job Title this position reports: Chief Financial Officer

Job Titles directly reporting to this position: None

Working Conditions: Work may be stressful at times due to continual interaction with others and the nature of the medical specialty.

Must possess the physical and mental abilities to perform the tasks normally associated with the role including bending, reaching and sitting.

Physical surroundings: Medical office

Adverse working environment Work may be stressful due to continual interaction with others, long hours required and nature of the medical specialty.

Physical Effort: Must possess the physical and mental abilities to perform the tasks normally associated with this role including prolonged sitting, walking, bending, standing, stooping and reaching. Lifting up to 10 pounds at times.

Local Travel: Occasional, within city limits only

Domestic/International Travel: None

Extensive Hours: Varies due to need

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this position. They are not intended to be an exhaustive list of all associated responsibilities, skills, efforts or working conditions. Mission Cancer + Blood reserves the right to change, amend, add, delete, and otherwise assign any and all duties, responsibilities and position titles as it deems necessary to meet the needs of the business.

Mission Cancer + Blood is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

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