The Coding Review Specialist is responsible for daily auditing, monitoring, and follow-up to ensure coding compliance. The Specialist assigns appropriate codes to patient diagnosis and procedures and provides support to the coding staff. The Specialist monitors and documents coding trends.
Responsibilities
- Responsible for performing coding compliance review
- Audits clinical documentation and coded data to validate documentation services rendered for reimbursement and reporting purposes
- Identifies discrepancies and billing issues; recommends a plan of action to correct discrepancies and prevent future coding errors
- Assures that accounts are grouped to the appropriate classification utilizing ICD diagnosis and procedure codes
- Reviews accounts assigned to work queue to determine if a clinical association exists for possible combined billing referencing various rules and regulations
- Monitors and reports the outstanding account reviews to facilitate account billing
- Ensures compliance with established guidelines and regulatory requirements
- Serves as a resource and subject matter expert to coding staff and interdisciplinary teams
- Assists in coordinating external third party annual coding audits
- Works with medical and business office staff to resolve coding issues and associated problems
- Serves as a liaison to Revenue Cycle to provide effective communication of concerns between Patient Financial Services and Coding Management
- Assigns ICD and CPT codes to patient diagnoses and procedures
- Ensures assignment of codes are consistent with coding guidelines and regulations
- Assigns Ambulatory Payment Classification (APC) promptly and accurately
- Groups patient diagnostic information according to regulations utilizing ICD diagnosis and procedure codes
- Enters coded and abstracted data into the hospital information system
Qualifications
Education:
Experience:
- 4 years as a medical coder for an acute care facility
Skills:
- Analyzing and organizing technical data
- Multitasking, time-management, and organization
- Verbal and written communication
