HB-PB Coding Spec II - Rural Health Clinics

wvumedicine; United States; Remote; USD 52,000 - 68,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a Medical Coding Specialist to interpret clinical documentation and assign ICD-10/CPT codes for inpatient and outpatient encounters. The role involves ensuring accurate coding, billing accuracy, and collaboration with physicians and revenue cycle teams.

Ideal candidates have a high school diploma, current HIM or coding certification (AHIMA/AAPC), and at least two years of medical coding experience, including physician office coding.

Qualifications

• High School Diploma or Equivalent.
• Current HIM or Coding Certification through AHIMA or AAPC.
• Two years of medical coding experience.
• Two years of physician office coding experience.

Responsibilities

• Reviews and interprets medical record documentation to identify all diagnosis and procedures and assigns ICD-10, CPT, or modifiers.
• Assigns hospital and/or professional codes to various patient classes (I/P, OBS, SDC, etc.).
• Performs the coding/billing Split Claims process to ensure correct coding and reimbursement.
• Ensures timely coding, charging and abstraction of accounts for assigned specialties.
• Maintains coding knowledge through reviews, in-services and study of coding manuals.
• Obtains information from physicians as needed to accurately code assignments and facilitates the billing process.
• Performs audits to assess provider coding accuracy and education as needed.
• Supports Revenue Cycle Operations in claim development to resolve problem accounts.

Skills

Medical coding

Education

High School Diploma or Equivalent

HIM Certification

Coding Certification (AHIMA/AAPC)

Job description

Minimum Qualifications

1. High School Diploma or Equivalent.
2. Current HIM or Coding Certification through ONE of the following:
   • American Health Information Management Association (AHIMA)
   • American Academy of Professional Coders (AAPC)

Experience

1. Two (2) years of medical coding experience.

Preferred Qualifications

1. Two (2) years of physician office coding experience.

Core Duties and Responsibilities

1. Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified. Assigns hospital and/or professional codes to a variety of patient classes (i.e. I/P, OBS, SDC, etc.)
2. Performs the coding/billing Split Claims process to ensure correct coding and reimbursement for appropriate accounts.
3. Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
4. Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
5. Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
6. Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.
7. Monitors on an ongoing basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.
8. Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

Physical Requirements

1. Must be able to sit for long periods of time.
2. Must have visual and hearing acuity within the normal range.
3. Must have manual dexterity needed to operate computer and office equipment.
4. Must be able to lift, push or pull 10-20 pounds.

Working Environment

1. Standard office environment.
2. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
3. May require travel.

Skills and Abilities

1. Must be able to concentrate and maintain accuracy during constant interruptions.
2. Must possess independent decision-making ability.
3. Must possess the ability to prioritize job duties.
4. Must be able to handle high stress situations.
5. Must be able to adapt to changes in the workplace.
6. Must be able to organize and complete assigned tasks.
7. Must possess excellent written and verbal communication skills.
8. Must meet quality and productivity standards.
9. Must possess knowledge of anatomy, physiology and medical terminology.

Additional Job Description

Scheduled Weekly Hours: 40

Shift:

Exempt/Non-Exempt: United States of America (Non-Exempt)

Company: SYSTEM West Virginia University Health System

Cost Center: 548 SYSTEM HIM Coding Analysis