Coding Specialist III

We are seeking a Coding Specialist III responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Responsible for developing coding and billing change procedures. Responsible for training on all coding and billing changes.

Specific Duties and Responsibilities

Procedural Knowledge

• Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
• Works closely with Office of Billing Quality Assurance to include review of documentation.
• Serves as departmental expert on coding questions.
• Exercises independent judgment and decision making on a regular basis with respect to code selection.
• Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies.
• Researches and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
• Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
• Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
• Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
• Review and resolve Epic Charge Review Edits daily.
• May act as a back up to Charge Entry when needed.
• Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.
• Works with Department Management to create Charge Review Rules to prevent unnecessary denials.
• Works with Department Management on maintenance of provider preference lists.
• Provides training on all coding changes to providers and staff. Develops presentations to effectively communicate how changes will affect provider billing and coding. Provide face to face training on changes to providers based at all Hopkins locations.
• Conducts monthly internal audits for level I and II coders

Technical Knowledge

• Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Working knowledge of JHU/ PBS Billing Applications.
• Utilize online resources to facilitate efficient claims processing.
• Capable of advance problem solving in medical billing and coding.

Professional & Personal Development

• Participate in on-going educational activities.
• Assist in the training of staff, providers, management and administration.
• Keep current of industry changes by reading assigned material on work related topics and provide updates to providers, staff, management and administration
• Complete three days of training annually.

Minimum Qualifications

• High School Diploma/GED. Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge.
• CPC certification. Specialty CPC certification or second AAPC certification.
• Five years coding experience with demonstrated analytical skills. Experience with Medicare regulations. Understanding of third party payer issues. Epic experience preferred. Additional education may substitute for experience to the extent permitted by the JHU equivalency formula
• Experience with Medicare regulations.
• Understanding of third-party payer issues.
• Excellent written and oral communication skills with the ability to communicate effectively with clinic staff, providers, bill staff, management and administration.
• Additional education may substitute for required experience and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.

Preferred Qualifications

• Epic experience.

Classified Title: Coding Specialist III

Role/Level/Range: ATO 40/E/03/OG

Starting Salary Range: $24.25 - $42.50 HRLY ($69,000 targeted; Commensurate w/exp.)

Employee group: Full Time

Schedule: M-F: 8:30-5:00

FLSA Status: Non-Exempt

Location: Remote

Department name: SOM DOM Billing

Personnel area: School of Medicine