Job Description: Specialist Coder
Argus Medical Management is a well established physician practice management company located in Long Beach, CA. We provide billing, staffing, credentialing, marketing, systems, accounting and purchasing services to over 300 physicians in L.A. and Orange Counties. We currently have an opening for a Specialist Professional Coder. Experience in Cardiology and Ortho coding is preferred.
The primary responsibilities are:
- Performs an ongoing audit of client accounts to ensure optimum reimbursement and coding compliance.
- Conducting a detailed review of patient medical records to assess the accuracy and appropriateness of the recorded medical coding for proper diagnosis and procedure
- Perform a detailed review of the patient medical records to validate that the diagnosis and procedure codes were coded and sequenced correctly
- Regularly provide remote educational sessions to outsourcing staff on:
- ICD-10, CPT-4 and HCPCS code changes and updates
- Coding policies, procedures, standards, expectations and techniques
- Error trends.
- Functions of the coding system
- Client specific guidelines
Staff Feedback (outsource):
- Assist in providing feedback and remediation to outsourcing teams
- Provide detailed summary to make adjustments to correct improperly paid claims and document the correct coding to be utilized
- Communicate quality issues to Remote Manager, Team Leaders and Coding Dept Manager.
- Provide recommendations to management based on audit findings
- Prepare management summary reports of audit findings
- Complete all scheduled QA per client
- Respond to client QA needs.
- Consult physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record
- Resolve any conflict or coding discrepancies with clients,
- Collaborate with and give feedback to clients regarding coding and documentation guidelines
- Educate clients on coding policy and/or procedure changes
- Provide support to the Coding Department Manager as required.
- Maintains detailed knowledge of coding guidelines and regulations
Qualification Experience and Skills Required
- Five (5) years coding experience.
- Multi-Specialty coding experienced required.
- Outpatient/Clinic billing experience required.
- Physician billing office supervisory experience preferred
- Knowledgeable in Hierarchical Condition Categories (HCC) concepts and documentation guidelines.
- Knowledge in MACRA reporting
- High School degree required. Some college preferred.
- Proficiency in medical billing systems.
- Knowledge in coding methodology State and Federal Billing Guidelines.
- Demonstrated expertise in current multi-specialty CPT-4, ICD-10, and HCPCS coding principles and practices including modifiers.
- Knowledge in Evaluation and Management Documentation guidelines. Performs E & M audit.
- Understanding of ICD-10-CM
- Ability to develop effective and professional training programs for staff.
- Proven ability to interact with physicians and support staff.
- Excellent verbal and written communication skills.
- Proficient in Word, Excel, Power Point & System Report Writer(s) as applicable.
- Ability to drive own transportation.