Job Description

Coding Specialist

Administrative Office - Coastal · BILLING
Laguna Niguel, CA
Revenue Cycle Management
Full Time, Days
Weekly Schedule: Monday - Friday
Bilingual: None
Bilingual Type: N/A
Posted 07/25/2022
Req # 9121

CODING SPECIALIST - HEALTHCARE

HYBRID OPPORTUNITY! (1-2 in the office - Laguna Hills, California, 3 days remote)

 

**Candidates should live within 30 minutes from Laguna Hills, California**

 

Qualified candidate should possess:

  • Reviewing and applying applicable diagnosis medical codes
  • Auditing medical charts and reviewing for accurate medical codes
  • Coding of diagnoses and procedures for in/out patient accounts
  • Knowledge of ICD-10, CPT-4 and HCPCS coding
  • Correspondence with Payors
  • Reimbursement, denial, revenue cycle management
  • 3+ years Coding experience required

 

Here we Grow! Because the need to care for children in this age is growing and changing, we are looking for an intelligent, caring Coding Specialist - Healthcare who will join a mission-driven group that is focused on the health of children and the well-being of the family from an operational perspective. Our healthcare practice has grown from its South Florida roots since 1955 across Texas, California, Arizona, New York and there is more to come. At Pediatric Associates, our employees receive competitive salary, a generous PTO program, competitive benefits including a 401K with a Company match of up to 3.5%. With over 65 years of providing LOVING CARE to our patients, we offer the stability and security of an established practice with the excitement of a growing healthcare organization.

Apply on line, email or call us directly, and learn why this is a rewarding career move for you! This is a wonderful time to join our Big Orange PA Family!

Benefits at a glance:

  • 3 Comprehensive Medical Plans
  • Part Time Medical Plan
  • Dental
  • Vision
  • Basic Life and Accidental Death and Dismemberment (AD&D) Company Paid
  • Long Term Disability (LTD) Company Paid
  • Short Term Disability (STD)
  • Voluntary Term Life Insurance (Employee/Spouse/Child)
  • 401K Retirement Plan
  • Voluntary Benefit Plans
  • Life Assistance Plan (EAP)
  • Tuition Reimbursement
  • Paid Time Off
  • Paid Holidays

 

 

PRIMARY FUNCTION:  The Coding Specialist is responsible for reviewing and applying applicable diagnosis, procedure codes, and modifiers as needed, in adherence with departmental policies for services provided by physicians and allied health providers and provide training and guidance to providers. 

Manage program for high-quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-10, CPT-4, and HCPCS coding classification systems, to meet billing system requirements. Manage the internal quality coding audit program. 


ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.) 

 

Support the collections department to maintain the expected level of quality from a coding perspective. This includes reporting trends and recommendations for potential quality enhancements.  

 

Audits medical record documentation to identify under-coded and up-coded services and prepares reports of findings to include: 

Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. 

Researches, analyzes, and responds to inquiries regarding inappropriate coding, denials, and billable services. Correction of daily coding errors/denials. 

 

Meet and maintain all departmental and personal production goals as directed by the Manager. Communicates areas of improvement from a provider documentation standpoint and creates formal recommendations. 

 

Participates in the ongoing review process, as directed by the Manager to assure the accurate application and coding of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-10), and/or the Health and Care Professional Council (HCPC) codes, the capture of all services provided, and that services which were not performed are not billed for. 

 

PERFORMANCE REQUIREMENTS: 

 

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations. 

 

TYPICAL WORKING CONDITIONS:  

Indoor Work 

Operating computer 

Reach Outward 

Manual dexterity 

Lift/Carry 20 lbs. or less 

Sitting 

 

Other Physical Requirements 

Vision 

Sense of Touch 

 

EDUCATION: High School Diploma or equivalent required. 

 

LICENSURE/CERTIFICATION: CPC, CPC-H, CCS, CCS-P, CPMA or RHIT Certificates preferred 

 

EXPERIENCE: Minimum 3 years of experience required. Experience in chart auditing in multi-specialty physician coding preferred. 
 
KNOWLEDGE, SKILLS & ABILITIES:
 

Knowledge of billing and coding policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.) Skilled in defining problems, collection of data, interpreting billing information and provider documentation.  

Ability to communicate effectively and clearly. 

Knowledge of auditing concepts and principles. 

Advanced knowledge of medical coding and billing systems and regulatory requirements. 

Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation. 

Knowledge of current and developing issues and trends in medical coding procedures requirements. 

Detailed knowledge of medical coding systems, procedures, and documentation requirements 

Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements. 

Ability to provide guidance and training to professional and technical staff in area of expertise. 

Application Instructions

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