Specialist Coding

MEDICAL CODING / BILLING CERTIFICATION (CPC ETC)

Job Summary :

Serve as a coding resource to staff throughout Kaiser Foundation Health Plan of Washington. Research coding issues regarding policies and guidelines from CMS and other payers.

Provide coaching on coding issues and concepts. Evaluate medical record documentation against coding and billing compliance standards and provide written documentation of findings.

Assist in maintenance, configuration and develop and implement coding improvement plans for Claim Editing System (iCES).

Essential Responsibilities :

Serves as the coding, documentation, reimbursement and compliance consultant to KFHPW healthpln staff. Demonstrates resource expertise on compliant coding and billing, and regulatory requirements.

Researches clinical specialties, coding changes and guidelines, Federal and State health care billing rules and regulatory requirements, and industry-standard billing practices.

Researches and responds to formal coding and provider reconsiderations resulting from Claim Editing System (iCES).

Assists in medical record documentation audits of patient care against services and diagnoses reported by providers, following coding guidelines and policies.

Provides written documenation of findings of the documentation audits to providers.

• Work with Coding Sr. Consult on reviews of the Claim Editing System (iCES) set-ups to assure that master files and tools are compliant with coding and billing rules.
• Makes recommendations on changes and enhancements to the Claim Editing System (iCES). Displays effective teamwork and leadership skills, setting and meeting deadlines and objectives for projects assigned;

leads and participates in committees as requested; effectively collaborates with other departments throughout the organization.

Identifies coding errors and process issues, provides feedback. Assists Coding Sr. Consultant before, during and after Claim Editing System (iCES) implementation changes.

Assist Coding Sr Consultant in assuring compliance, assessing and providing appropriate education with respect to accurate and compliant coding in Claim Editing System (iCES).

Evaluates medical record documentation against coding and billing standards and provides written documentation of findings.

Basic Qualifications :

Experience

Minimum three (3) years of experience in medical claims.

Education

High School Diploma OR General Education Development (GED) required.

License, Certification, Registration

N / A

Additional Requirements :

• Ability to work independently and collaboratively.
• Skills utilizing evidence based problem solving.
• Teaching, coaching and communication skills.
• Analytical and motivational skills.
• Personal relation and customer service skills.
• Computer skills in a Windows environment, including MS Word, Excel, and Access.
• Ability to identify resources and research policies and procedures.
• Working knowledge of medical coding policy.
• Demonstrated ability to make technical and administrative decisions within specific guidelines.
• Able to obtain CPC, CCS-P, RHIT, RHIA, CCS, CPC-H certificate by, or eligibility soon after, date of hire / transfer.

Preferred Qualifications :

• Extensive knowledge of medicare compliance issues and health care coding, billing, and reimbursement in a fee-for-service environment.
• Five (5) years of experience in medical claims
• Auditing experience.
• Knowledge of ICD-9CM, CPT and HCPCS coding.
• Completion of a vocational school program in health information technology or medical secretary OR college courses in medical terminology, medical science, and disease processes, anatomy, physiology, and ICD-9, CPT, and HCPCS coding guidelines as required to achieve specified experience.
13 days ago