OP Coding Specialist, Uncertified

Overview:

• The OP Coding Specialist is responsible for reviewing the office and hospital charges prior to billing to evaluate for accuracy using knowledge of hospital outpatient coding rules.
• Reviews denials in the Follow-Up work queues and updates insurance and demographic issues causing claim denials.
• Works collaboratively with team members to answer questions and/or resolve issues related to documentation, coding and billing of oncology services
• Communicates with insurances carriers to resolve claims issues as well as work with Management to communicate system issues.
• Navigate payer websites and follow proper telephone etiquette.
• Completes estimates for treatments

Position is on-site with the ability to be remote or hybrid after initial training period.

Responsibilities:

• Assigns sequence (primary, secondary, etc.) according to coding guidelines and enters codes into the electronic system to provide data for billing and reimbursement
• Uses appropriate diagnoses codes, CPT codes and modifiers in the coding of hospital outpatient oncology services
• This position evaluates medical records and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines for technical Radiation Oncology and Medical Oncology services
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
• Maintains current knowledge of ICD diagnosis codes, CPT physician service codes, , and governmental (Medicare, Medicaid, TriCare), commercial and managed care regulations by reading relevant professional literature and by attending workshops and lectures
• Accrues sufficient continuing education hours to maintain national coding certification
• Works collaboratively with team members to answer questions and/or resolve issues related to documentation, coding and billing of oncology services
• Resolves pending charges in the Epic workqueues
• Work all assigned billing edits related to radiation oncology technical and medical oncology within EMR.
• Performs other related duties incidental to the work described herein

Qualifications:

Qualifications:

Successful completion of college level courses in medical terminology and anatomy and physiology required.

Six months to one year outpatient coding work experience using ICD-10_CM required.

Coding experience with Oncology and/or Primary Care preferred.

CPC, ART, CCS, RHIT, COC, or CHONC verification preferred.