Coding Specialist

Overview

The Coding Specialist plays a critical role in ensuring accurate coding, compliance, and reimbursement for the Department of Surgery.

Responsibilities

• Coding & Reimbursement : Review provider documentation and assign the most accurate ICD-10 and CPT codes at the highest level of specificity to ensure appropriate billing and maximize reimbursement from third-party payors.
• Compliance & Education : Support physician and staff education on EVMS Medical Group Compliance Guidelines, HCFA Teaching Physician Guidelines, and industry coding standards. Provide feedback based on results of chart audits.
• Auditing & Documentation Review : Assist with internal departmental "mini-audits" to confirm that inpatient and outpatient medical records contain sufficient documentation to justify the type and frequency of billed services.
• Revenue Integrity : Ensure charges are submitted accurately and compliantly, directly impacting the Department's ability to optimize revenue while minimizing risk.
• Departmental Impact : Maintain financial accuracy, compliance with federal and institutional guidelines, and safeguard the Department's reimbursement streams. Bridge clinical documentation, compliance, and billing to protect the Department from compliance risk and strengthen revenue performance.
• Essential Duties and Responsibilities : Conduct monthly provider and staff coding and compliance education classes as needed; assist with implementing procedures for compliance within the surgery setting; develop Surgery compliance, coding, and billing policies and procedures; review and work monthly denials and physician charges; ongoing review of compliance, coding, and billing literature and guidelines affecting academic medicine and surgery practice; perform internal quality assurance charge / chart audits; research and assign the appropriate CPT / ICD-10 code based on the physician's dictation and other medical records; audit the appropriateness of CPT and ICD-10 coding to ensure correct linkage between coding procedures; serve as liaison between physicians, data entry staff, and the Medical Group Billing Office; review monthly charge allowance reports to maximize reimbursement; supervise charges entered into patient records adhering to carrier regulations; ensure documentation supports diagnoses, procedures, and treatment results; identify discrepancies and implement corrective actions; perform other duties as assigned.

Education and Experience

Education : Associate degree.

Experience : Four years of prior experience with CPT / ICD-9 & ICD-10 coding is required, including comprehensive understanding of all insurance types and requirements. Current CPC certification is required and must be maintained annually. Surgery coding experience is a plus.

Location : US-VA-Norfolk

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