Coding Specialist-Clinic, FT, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary

Reads and abstracts data from inpatient, observation records and patient records. Assigns diagnosis and procedure codes based on current regulations and coding guidelines.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values : Inspire health. Serve with compassion. Be the difference.

Validates ICD-9 and CPT codes for compatibility and medical necessity for services performed by Prisma Health physicians and or practices, while utilizing the correct coding initiative to ensure minimal coding errors and rejections through Claims Manager and the Test Edit process. Maintains coding and documentation compliance through the practice documentation compliance process. Provides feed back to the practices to ensure correct coding and documentation compliance based on Medicaid / Medicare and federal teaching guidelines.

Processes claim rejection reports and med-assets reports and interacts with collectors and internal team members to analyze claim rejections by all carriers to improve and correct coding related reimbursement issues. Reviews rejection reports to capture possible auto adjustment errors for revenue capture. Works with internal team members and writes-up charge corrections for billing corrected claims

Meets with management and practice staff to discuss billing and reimbursement issues and changes for the purpose of improving departmental billing and reimbursement processes. Make recommendations for change to departmental procedures in accordance with current practices and procedures. Attends meetings, conferences and seminars, as approved by department, to remain updated on latest billing procedures. Attends mandatory educational training sessions covering Prisma Health Compliance guidelines on an annual / regular basis. Maintains yearly CPC renewal and CEU requirements.

Provides coverage to maintain department, billing and coding operations. Obtains medical / clinical and demographic information from ECW, Sovera, GE / IDX systems for coding process as well as outside sources such as Coding Q&A Medicaid and Medicare websites. Provides coding information and resolutions to physicians, practices, business office staff, accounts receivable and management

Performs other duties as assigned.

Supervisory / Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

Education - High School diploma or equivalent

Experience - Two (2) years of experience in physician inpatient / outpatient billing, coding.

In Lieu Of

N / A

Required Certifications, Registrations, Licenses

CPC preferred

Knowledge, Skills and Abilities

Knowledge of anatomy, physiology and medical terminology

Participates in coding and educational meetings in order to maintain coding accuracy and compliance w / physicians, practices, business offices, Med-assets group, Test Edit committee, or staff as well as management.

Maintains and enhances current knowledge of billing and coding practices at meetings and seminars, study of reference material and updates to coding manuals.

Reviews newsletters, notices and updates to coding manuals to maintain current knowledge of applicable billing and coding practice and procedures.

Work Shift

Day (United States of America)

Location

Clemson-Seneca Pediatrics

Facility

1089 Clemson-Seneca Pediatrics - Clemson

Department

10896820 Rural Health

Share your talent with us! Our vision is simple : to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.