Coding Specialist Resume Samples
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Coding Specialist Resume Samples
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182 Adah Ramp
Houston
TX
+1 (555) 960 4054
182 Adah Ramp
Houston
TX
Phone
p
+1 (555) 960 4054
Experience
Experience
New York, NY
Coding Specialist
New York, NY
Hermann-Conroy
New York, NY
Coding Specialist
- Reviews medical records to codes patient charges
- Reviews physician documentation and performs audits to determine accuracy
- Updates late charges and processes in a timely manner
- Prepares reports as requested by operations team
- Provide training to physicians and staff to improve coding outcomes
- Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources
- Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement
San Francisco, CA
Physician Services Coding Specialist
San Francisco, CA
Lubowitz Group
San Francisco, CA
Physician Services Coding Specialist
- Problem-solve insurance rejections and denial issues by working TES and PCS work files
- Uphold productivity standards / daily quota set by management
- Uphold productivity standards set by management
- Uphold productivity standards and daily quota set by management
- Demonstrate a good working knowledge of medical terminology, human anatomy, and coding
- Mentor and assist in new employee training
- Maintain company accuracy rate of 95% in monthly internal audits
present
Phoenix, AZ
Certified Procedural Coding Specialist
Phoenix, AZ
Auer-Cassin
present
Phoenix, AZ
Certified Procedural Coding Specialist
present
- Provides resident and faculty education for coding and compliance and assists the Practice Administrator and the Residency Program Director in the development of a curriculum for coding and compliance, audits to ensure that the deadline for completing EMR is adhered to by all providers, and leads monthly noon conferences with Faculty/Residents per the coding/compliance curriculum and assists the Compliance Office Manager in annual HIPAA training for Residents/Faculty
- Contact outpatient clinical areas, where necessary to clarify coding-related issues in documentation
- Periodically reports to management on all revenue cycle matters involving registration, scheduling, eligibility, benefits, ABNs, pre-certification service, e-bill, and charge capture
- Participates in the orientation and/or training of new staff
- Completes and maintains documentation of continuing education hours annually
- Sends flags to resident/faculty advising them of delinquent charts and advises faculty mentor of non-compliance for completion of charts
- Assigns diagnosis and procedure codes for each patient encounter, conforming to ICD-10-CM and CPT guidelines
Education
Education
Bachelor’s Degree in Health Information Management
Bachelor’s Degree in Health Information Management
Howard University
Bachelor’s Degree in Health Information Management
Skills
Skills
- Ability to multi-task, manage details and organize efficiently and effectively
- Ability to interact with patients, medical and administrative staff, and the public effectively
- Intermediate knowledge in Microsoft Excel including: Pivot Charts, V/H lookups, Match Function, Formula creation
- Ability to use EMR, other relevant computer hardware and software, telephone, copier, fax machine and other standard medical office equipment
- Ability to set priorities among multiple requests
- Ability to read, interpret, and apply policies and procedures
- Manufacturing processes a strong
- Skill in analyzing situations accurately and taking effective action
- Skill in computer hardware and software use
- Skill in verbal and written communication
15 Coding Specialist resume templates
Read our complete resume writing guides
1
Coding Specialist Resume Examples & Samples
- Follow detailed coding guidelines to create codes and input BOMs into SAP
- Enter Material Master parameters into the SAP
- Life Cycle Management of Finished Goods and BOMs
- Run SAP queries daily/weekly to ensure Item Master data accuracy, update data per the results of output
- Close collaboration including participating in bi-weekly meetings with other departments on a regular basis to ensure all information in the system(s) is correct
- Close collaboration with departments: New Product Development, Technical Packaging, Planning, Trade Customization and Design, and Manufacturing
- Follow-up, as necessary, to resolve outstanding issues and open items
- Utilize and incorporate all available system resources in daily work process (i.e., SAP queries, Excel, Winshuttle software, etc.)
- Use Excel to generate KPI (Key Performance Indicators) daily/weekly/monthly reports
- Find new ways to improve and automate the current coding process
- Manufacturing processes a strong plus
- Experience with systems: SAP – Master Data and BOMs
- Intermediate knowledge in Microsoft Excel including: Pivot Charts, V/H lookups, Match Function, Formula creation
- Detail oriented
- Strong communication and follow up
- Excellent verbal and written communication skills
- Proof reading skills including data accuracy
- Excellent interpersonal skills and problem solving ability
- Time management & organizational skills
- Comfortable learning new technology
- Customer Service Focused
- High Energy Level and Willingness to Learn
- Proactive and “Can Do” Problem Solving
- Focus on continuous process improvement
- Team Oriented
- Excellence in Execution
- Organized in Action
- Constructive Networker
2
Certified Billing Coding Specialist Resume Examples & Samples
- Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Support the Senior Medical Billing and Coding Specialist to respond to audit findings and make applicable coding additions or corrections
- Registers and analyzes claims in the EMR system, including insurance verification and charge entry. Tracks and requests outstanding claims for assigned departments/facilities
- Reviews Medicare Local Coverage Determination (LCDs) and Medicare bulletin updates
- Utilizes the EMR system to run required daily/monthly/quarterly reports on claims entered. Accepts assignments from management and maintain open communication with their manager to resolve quality and production issues
3
Remote Certified Coding Specialist Resume Examples & Samples
- CCS credentialed or RHIT certification
- Extensive knowledge of ICD-9 coding and DRG reimbursement
- Knowledge and experience with coding guidelines and standards
- 3-5 years of Inpatient coding experience
- Strong writing and computer skills
- Medicare reimbursement methodologies knowledge
- Nurse Coder (RN/LPN with CCS credentials)
4
Senior Medical Records Coding Specialist Resume Examples & Samples
- 2+ years of Medical Coding experience
- Knowledge of ICD-CM (current edition) and ICD-PCS coding systems
- 5+ years of Medical Coding experience or related work experience
- Knowledge of 3rd Party Payer requirements and Federal / State guidelines and regulations pertaining to Coding and Billing practices
5
Medical Billing & Coding Specialist Resume Examples & Samples
- Certified Professional Coder proficient in ICD 10
- Demonstrated understanding of the billing revenue cycle
- Proven ability to multitask
- Experience with appeals
- 3+ years or total experience, preferably in ASC
- 2+ years of experience working with insurance
- Extensive knowledge of policies and coverage
- Professional telephone etiquette
- Knowledge of aging reports
6
Compliance Coding Specialist Resume Examples & Samples
- 2+ years of progressive provider Coding / Training experience
- Medical Coding certification required
- AAPC Certificate of ICD-10-CM proficiency
- Advanced knowledge of Medical terminology, accepted Medical abbreviations and their meanings
- Knowledge in the use of specialized references such as the ICD-9/ICD-10, CPT books
7
Bwpo Coding Specialist Resume Examples & Samples
- Responsible for accurately coding all diagnostic and surgical procedures for the Radiology Department
- Utilize various information systems to maximize efficiency. This includes using IDX, BICS, computer assisted coding and other database systems to process accurate medical billing and obtain accurate demographic information on patients
- Meets quantitative and qualitative standards established by policy
- Participation in data validation and productivity studies with discussion of identified problems
- Works with the business office on any and all follow up related to the Group’s billed accounts. This includes providing updated patient demographic and financial information, documentation to support billed procedures, authorization numbers and other information as needed to ensure maximum reimbursement
- Responsible for tracking coding issues by provider, section and location with a goal of providing necessary training to improve coding
- Keeps informed of third party regulations in billing/reimbursement and maintains files of coding publications
- Participates in continuing education programs to ensure that coding knowledge remains current
- Provides backup support to other billing staff and handles special projects as assigned by the manager of the radiology billing operations
- Maintenance of confidentiality is essential for this position
- All duties will be performed on-site in an office environment and possibly remotely
- All other duties as assigned
- 3-5 years of ICD-9 and CPT coding with an emphasis on Radiology specific coding
- ICD-10 coding knowledge
- Experience with E&M Coding advantageous
- CPC, CCS-P, or CCS certification is required
- Experience in healthcare setting and knowledge of 3rd party Radiology billing requirements preferred
- EPIC experience helpful
- 1 Ability to work independently and interact with all levels of staff
- 2 Highly organized self starter with excellent problem solving skills
- 3 Ability to present findings and discuss issues with providers confidently and effectively
- 4 Accuracy with a strong attention to detail
- 5 Ability to handle a high volume
- 6 Proficient written and oral communicator
- 7 Strong organizational skills
- 8 In depth understanding of ICD-9 and CPT coding
- 9 Ability to work both independently and as part of a team
- 10 Ability to work under pressure, multi-task and meet deadlines
- 11 Familiarity with common office equipment and business software
8
Claims Coding Specialist Resume Examples & Samples
- Reviews and responds to written provider disputes, clearly and articulately outlining the payment discrepancy to the provider
- Navigate CMS and State specific websites, as well as AMA guidelines, and compare to current payment policy configuration in order to resolve the providers payment discrepancy
- Review medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim adjustment is necessary
- Processes claim adjustment requests in Xcelys following all established adjustment and claim processing guidelines
- Identifies and escalates root cause issues to supervisor for escalated review
- Acts as liaison with other departments when additional clarification is needed about claims payment policy disputes
- Assists team members with training opportunities and coaching
- Assists with special projects as assigned or directed
- LI-JL1
- Required 3+ years of experience in claim coding, claim processing or billing in a healthcare environment
- Preferred 1+ year of experience in claims coding
- Intermediate Other Ability to quickly research and absorb new payment systems
- Intermediate Other Knowledge of Medicare and Medicaid payment systems
- Required Intermediate Other Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
- Required Intermediate Other Billing expertise in UB92, UB04, HCFA 1500 and/or other healthcare services
9
Claims Coding Specialist, Senior Resume Examples & Samples
- Reviews and responds to written and telephonic provider disputes, clearly and articulately outlining the payment discrepancy to the provider
- Thoroughly researches post payment claims and takes appropriate action to resolve identified issues within turnaround time requirements and quality standards
- Processes claim adjustment requests in system following all established adjustment and claim processing guidelines
- Utilize SharePoint and Excel as necessary to work through daily inventory assignments
- Identifies and recommends modifications to payment policies once root cause has been established and works with team leadership to implement changes and communicate modifications to the team
- Reviews and responds to internal escalated provider disputes transferred by management and other associates
- Acts as liaison with other departments and external market and providers when additional clarification is needed about claims payment policy disputes. Coordinate evaluation of change requests from clinical, financial and claims operation perspective
- Participate in calls with market representatives and team leadership to work through complex provider disputes and payment policy interpretation disputes
- Assists with reviewing root causing audit errors
- Work with IT or operations to determine root cause of errors on vendor report
- Assists team members with training opportunities and coaching, including producing team communications regarding how to research/root cause
- Required 4+ years of experience in claim coding, claim processing or billing in a healthcare environment
- Required 1+ year of experience in claims coding
- Advanced Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Required Advanced Other Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
- Required Advanced Other Billing expertise in UB92, UB04, HCFA 1500 and other healthcare services
10
Physician Services Coding Specialist Resume Examples & Samples
- Assign ICD-9, CPT-4 & HCPC codes from documentation
- Problem-solve insurance rejections and denial issues
- Maintain company accuracy rate of 95% in monthly internal audits
- Meet deadlines and complete assignments before monthly closing dates
- Maintain strictest confidentiality
- CPC or CCS-P or equivalent certification
- Must possess knowledge of third party reimbursement regulations and billing practices
- Possess moderate knowledge of level 1 & 2 modifiers
- Ability to examine documents for accuracy and completeness
- Ability to understand and follow compliance issues of moderate complexity
- Must possess moderate knowledge of CCI edits and LCDs and be able to accurately apply regulation knowledge to coding situations
- Radiology coders must be able to code the following modalities: level I, plus duplex and Doppler ultrasounds, CT’s/CTA’s, MRI’s, nuclear medicine, and basic IR procedures
- Multi-specialty coders must possess correct coding E&M and at least 2 other specialties
- Proficient in Microsoft Word, Excel
11
Cpc-coding Specialist Resume Examples & Samples
- Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources
- Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement
- Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code of Conduct; adhering to federal and state laws, rules, regulations, and corporate policies and procedures policies that affect his/her specific job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner
- Reviews medical records to codes patient charges
- Reviews physician documentation and performs audits to determine accuracy
- Updates late charges and processes in a timely manner
- Reviews tasks and corrects codes as needed
- Prepares reports as requested by operations team
- Provide training to physicians and staff to improve coding outcomes
- Additional responsibilities as needed
- Knowledge of ICD–9 and ICD–10 coding guidelines
- Knowledge of medical terminology
- Knowledge of billing applications
- Knowledge of the policies and procedures of the organization to complete coding tasks within compliance of the federal, state and organization regulations
- Skill in multi-tasking
- Skill in customer service
- Skill in computer hardware and software use
- Skill in verbal and written communication
- Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives
- Skill in analyzing situations accurately and taking effective action
- Skill in establishing and maintaining effective working relationships with employees, policy-making bodies, third-party payers, patients, and the public
- Skill in organizing work, making assignments, and achieving goals and objectives
- Skill in exercising judgment and discretion in developing, applying, interpreting, and coordinating departmental policies and procedures
- Ability to multi-task, manage details and organize efficiently and effectively
- Ability to read, interpret, and apply policies and procedures
- Ability to set priorities among multiple requests
- Ability to interact with patients, medical and administrative staff, and the public effectively
- Ability to use EMR, other relevant computer hardware and software, telephone, copier, fax machine and other standard medical office equipment
12
Coding Specialist Associate Resume Examples & Samples
- CPC-A certifications
- Experience with and exposure to compliance matters
- Specific knowledge of the regulations and guidelines as they relate to documentation and coding
- Superior verbal, written, organizational and interpersonal skills
- Competency with Microsoft Office (Excel, Word and PowerPoint)
- Solid ability to organize and prioritize workload to manage multiple tasks and meet deadlines
- Experience with revenue management or background from the healthcare industry
- 2+ years of coding experience
- CPC, CCS, CCS-P, CPMA, CEMC or CENTC certification
- Compliance certifications (CHC, CPCO) and/or Bachelor's Degree
13
Documentation & Coding Specialist Resume Examples & Samples
- Monitors and reviews coding accuracy, documentation and/or clinical status determinations to support professional fee coding
- Functions as quality assurance coordinator and technical support for coding/documentation and/or clinical necessity applications, education and references. Measures and maintains compliance standards for coding procedures. Conducts quality control studies of coded data and billed services to ensure compliance
- Assists with review, development, modification and implementation of compliance policies and procedures to achieve and maintain compatibility with billing requirements. Advises and instructs physicians and other providers regarding billing and documentation policies, procedures and regulations. Interacts with physicians and other providers to obtain clarification of conflicting, ambiguous or non-specific medical documentation
- Participates in the design and updates of billing forms and billing system dictionaries and/or coding documentation queries to ensure that all ICD-10 and CPT-4 codes are up-to-date and/or documentation is accurate and complete from both compliance and reimbursement perspectives
- Performs other related duties as assigned or requested. The university reserves the right to add or change duties at any time
14
Coding Specialist Resume Examples & Samples
- Position may work from home following necessary training and must be available for onsite training and team meetings. (This position is not able to accomodate working from another state remotely)
- To be successful, the Coder must be able to
- Code and abstract clinical and demographic data for inpatient, outpatient, or clinic encounters using standardized coding regulations, abstracting rules, and Fairview guidelines
- Identify and resolve clinical documentation and charge capture discrepancies to improve quality of the clinical documentation, severity and reimbursement levels assigned, integrity of charges data reported
- Educate multidisciplinary team members, including physicians, as it pertains to frequently changing mandated rules, regulations and guidelines to ensure a complaint claim
- Meet departmental quality and productivity standards
- Certificate program in coding or associate degree in HIM or a certificate with 1-3 years of healthcare experience (MA, HUC, Revenue Cycle)
- Knowledge of ICD9/ICD 10, CPT and related coding/abstracting rules and guidelines
- Knowledge of medical terminology
- Knowledge of anatomy, physiology, and pathophysiology
- Knowledge of relationship of disease management, medications and ancillary test results on diagnoses assigned
- Proficiency with computer systems, including electronic health record
15
Coding Specialist Resume Examples & Samples
- Reviews medical records to codes patient charges
- Reviews physician documentation and performs audits to determine accuracy
- Updates late charges and processes in a timely manner
- Reviews tasks and corrects codes as needed
- Prepares reports as requested by operations team
- Provide training to physicians and staff to improve coding outcomes
- Knowledge of ICD–9 and ICD–10 coding guidelines
- Knowledge of billing applications
- Knowledge of the policies and procedures of the organization to complete coding tasks within compliance of the federal, state and organization regulations
- Skill in multi-tasking
- Skill in customer service
- Skill in computer hardware and software use
- Skill in verbal and written communication
- Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives
- Skill in analyzing situations accurately and taking effective action
- Skill in establishing and maintaining effective working relationships with employees, policy-making bodies, third-party payers, patients, and the public
- Skill in organizing work, making assignments, and achieving goals and objectives
- Skill in exercising judgment and discretion in developing, applying, interpreting, and coordinating departmental policies and procedures
- Ability to multi-task, manage details and organize efficiently and effectively
- Ability to read, interpret, and apply policies and procedures
- Ability to set priorities among multiple requests
- Ability to interact with patients, medical and administrative staff, and the public effectively
- Ability to use EMR, other relevant computer hardware and software, telephone, copier, fax machine and other standard medical office equipment
16
Orthopedic Coding Specialist Resume Examples & Samples
- Reviews medical records to codes patient charges
- Reviews physician documentation and performs audits to determine accuracy
- Updates late charges and processes in a timely manner
- Reviews tasks and corrects codes as needed
- Prepares reports as requested by operations team
- Provide training to physicians and staff to improve coding outcomes
- Knowledge of ICD–9 and ICD–10 coding guidelines
- Knowledge of billing applications
- Knowledge of the policies and procedures of the organization to complete coding tasks within compliance of the federal, state and organization regulations
17
Coding Specialist Resume Examples & Samples
- CPT and ICD-9 coding experience and understanding
- Computer and 10-key skills required; data entry experience preferred
- Ability to reconcile and balance computer entries
- One year experience in customer service
18
Coding Specialist Resume Examples & Samples
- Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources
- Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement
- Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code of Conduct; adhering to federal and state laws, rules, regulations, and corporate policies and procedures policies that affect his/her specific job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner
- Additional responsibilities as needed
- Skill in analyzing situations accurately and taking effective
19
Centralized Coding Specialist Resume Examples & Samples
- Provides Home Health coding and OASIS/485 review for assigned agencies
- Reviews OASIS and assigns accurate codes that are supported by documentation
- Applies knowledge of medical terminology, disease processes, and pharmacology
- Demonstrates tested quality and integrity skills
- Able to make independent decisions regarding accurate ICD-9-10-CM
20
Network Program Manager, Coding Specialist Resume Examples & Samples
- Direct cross-functional and/or cross-segment teams
- Assists providers in understanding the Medicare Stars quality program as well as CMS -HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
- Utilizes analytics and identifies and targets providers
- Monitors Stars quality performance data for providers and promotes improved healthcare outcome
- Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resource
- Assist providers in understanding the Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
- Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
- Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
- Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured
- Provides thorough, timely and accurate consultation on ICD-10 and/or CPT 2 codes by providers or practice clinical consultants
- Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment
- ProvidesICD10 - HCC coding training to providers and appropriate staff
- Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
- Develops and delivers diagnosis coding tools to providers
- Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
- Educates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
- Performs analysis and provides formal feedback of to providers on a regularly scheduling basis
- Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
- Reviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assigned
- Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
- Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
- Bachelor’s degree (preferably in Healthcare or relevant field), or CPC (Certified Professional Coder with American Health Information Management Association or American Academy of Professional Coders) or willingness to obtain required certification within first year in position
- Previous experience in Risk Adjustment and HEDIS/STARs
- Minimum 4-6 years of clinic or hospital experience and/or managed care experience
- Knowledge of ICD10
- Advanced proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)
- Ability to travel approximately 25% with occasional overnights
- Demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders
- Knowledge of EMR for recording patient visits
- Previous experience in management position in a physician practice
- Minimum of one year of coding performed at a health care facility
- Knowledge of billing/claims submission and other related actions
21
Coding Specialist Resume Examples & Samples
- Coding experience or appropriate certification plus experience working within a physician practice
- Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
- Adheres to and exhibits our core values
22
Coding Specialist Resume Examples & Samples
- Assists in upholding coding team expectations of effective communications, including , customer service standards, professionalism, operating procedures, processes, and other team strategies and goals
- Assist in promoting a culture of support, continuous learning, and team work
- Adheres to all UTSW and departmental policies and procedures to include the Remote Coding Agreement where applicable
- Other Duties: Performs other duties as assigned
23
Remote Inpatient Rehab & Inpatient DRG Coding Specialist Resume Examples & Samples
- Extract and analyze clinical information and translate into the most accurate ICD-10-CM and ICD-10-PCS codes for IRF (Inpatient Rehabilitation Facility) and DRG (Diagnostic Related Group) accuracy and compliant reimbursement in accordance with the Center of Medicare and Medicaid Services (CMS). Primary responsibility in IRF Coding
- Concurrently extract, review and analyze clinical information, identify and abstract all pertinent information and translate data into appropriate codes for IRF-PAI, UB-04, Impairment Group, POA and PSI indicators, research, statistics, financial planning, compliance and marketing to ensure completeness, accuracy and compliance with established guidelines of all governmental regulatory agencies and third party payers
- An Associate's Degree in Health Information Technology and registration with the American Health Information Management Association as a RHIT or RHIA is necessary. Certification must be maintained through continuing education
- Experience in a major academic medical center and ICD-10-CM/PCS and Inpatient Rehabilitation Facility coding
24
Coding Specialist Resume Examples & Samples
- Certification in medical record coding (CPC, CCP, CCS)
- One to three years coding experience, ICD-9 & ICD-10 knowledge
- Must maintain annual continuing education requirements and remain in good standing with the certification governing body
- Must be willing to sit for and successfully pass the CPMA exam
- Effective written and verbal communication skills
- Analytical, organizational and time management skills
- Working knowledge of MS Excel and Word
- Overtime as needed
- Proficiency with MS Access
- Team building skills
25
Clinical Documentation Coding Specialist Resume Examples & Samples
- Possess a university/college degree/diploma in finance, business administration, health information management or a regulated health profession
- Current registration with Canadian Health Information Management Association
- Minimum 5 years’ acute care coding experience in a large hospital environment
- Knowledge of Canada’s health care system, preferably by province, Canadian Patient-based Funding initiatives and CIHI’s patient classifications (CMG+), Resource Intensity Weighting(RIW), the Ontario Ministry of Health’s HBAM Inpatient Grouper (HIG) and HBAM Inpatient Grouper weights (HIG weights)
- Knowledge of clinical procedures and treatments in order to conduct detailed analysis and develop recommendations, and population health care priorities
- Strong understanding of healthcare business process and technology preferred
- Project management theories and principles in order to plan and lead several concurrent projects for both staff and external experts
- Oral and written communication skills to coordinate, prepare and present results of analysis, findings or recommendations
- Ability to work independently and as a team member across multiple teams
- Ability to independently research and perform analysis to resolve complex issues
- Ability to understand customer requirements and their impact on technical directions of a solution
- Must be self-motivated, detail-oriented and able to manage one's own work independently in a fast-paced environment with changing priorities
- Must be able to maintain professionalism and react to customers appropriately while exhibiting the highest level of customer service
- Proficient in the use of Microsoft Office tools (Excel, Word, Powerpoint, etc)
- There will be some travel which may involve overnight stays
- Knowledge of 3M Codefinder is an Asset
26
Reference Data Coding Specialist Resume Examples & Samples
- Analyze the current local characteristics that exist for the US and understand
- Competent in database administration/data entry
- Minimum bachelor degree
- 1-2 years of experience in Operations or similar roles
- Expert knowledge of FMCG categories preferable
- A self-starter and driven associate
- Self-motivated with good time management skills and ability to work to deadlines
- Flexible to work across different time zones
- Proficient user of Excel and database systems software
- OGRDS knowledge nice to have, not a must
27
Coding Specialist Resume Examples & Samples
- Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes, coding guidelines, and teaching physician documentation guidelines through participation in continuing education programs
- Maintains a thorough understanding of the intricacies of the various patient types cared for at UTSW (inpatient, same day surgery, interventional procedures as examples) so work assignment adjustments can be made with little workflow disruption and coding coverage can be appropriately provided
- Mentors the work of lower level designated coding employees to ensure quality of work and growth in knowledge and expertise
- Assists in upholding coding team expectations of effective communications, including customer service standards, professionalism, operating procedures, processes, and other team strategies and goals
- Assists in promoting a culture of support, continuous learning, and team work
28
Physician Coding Specialist Resume Examples & Samples
- Reviews and evaluates patient medical records to determine the level of Evaluation and Management (E/M) service, identify office non-E/M procedures, surgical and interventional procedures and diagnoses. Accurately assigns and sequences CPT, modifiers and ICD codes. Abstracts and validates information
- Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes
- Keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to manager. Monitors, investigates and takes appropriate action for records that are not coded, billed or rejected
- Licensure / Certification: Certification in coding (CPC, COC, CCS, CCS-P, RHIA, RHIT) required. Certification in coding of physician services (CPC, CCS-P) preferred
- Experience: Formal training in CPT and ICD coding or previous work experience utilizing
29
Risk Adjustment Coding Specialist Saint Alphonsus Health Alliance Resume Examples & Samples
- High school diploma or equivalent required. Associate Degree or some college preferred
- Coding certification required. Certified Risk Adjustment Coder preferred or willingness to obtain within first 12 months of employment
- Develops and implements annual coding and documentation chart auditing process to include appropriate team members to ensure compliance and timeliness of completion to meet payor deadlines for submission
- Serves as HCC subject matter expert and network resource for primary care and specialty practices participating in the Saint Alphonsus Health Alliance
- Develops and implements risk adjustment education programs to support providers and staff to increase knowledge of quality and CMS-HCC Risk Adjustment driven payment methodologies and the importance of proper chart documentation of procedures and medical conditions
- Conducts focused quality performance and risk adjustment audits in physician offices either via on-site review or remote login of databases, such as clinical registries and electronic medical records
- Evaluate individual provider documentation practices to identify areas for improvement in quality and specificity. Initiate both group and one-on-one training and/or recommendations for additional areas of training
- Document and report provider and practice engagement to leadership team
- Reviews payor data to identify coding opportunities
- Validates accuracy of HEDIS/coding data and inputs/uploads data into payor portals
- Monitors HEDIS/5 Star and risk adjustment progress across the network
- Review high risk/high cost reports to identify patients appropriate for Care Management services
- Supports the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) chart audit process January through March
- Responsible for scheduling meetings to include physician peer review activities
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Quality Assurance Coding Specialist Resume Examples & Samples
- Assists Manager with research, resolution and response of error appeals/rebuttals
- Communicate effectively with Risk Adjustment Staff, nurse reviewers and physicians and ancillary departments as necessary to address issues and concerns
- Completion of special projects including claims and/or coding related audit support
- Identify error trends to determine appropriate training needs and suggest modification to policies and procedures
- Maintain employee/insured confidentiality. Provide assistance to other departments as requested. Compile and report statistical data to internal and external customers
- Provide training to new Coding team staff as needed
- Responds to the needs of internal Health Plan Departments (Risk Adjustment, Medicare or FWA etc.) and external customers (Ovation, Health System Coding Team, etc.)
- Review Diagnosis codes submitted internal/external coders/reviewers and the medical record documentation to ensure the recommended diagnosis code and meets governmental agency requirements for submission
- Utilize standard coding guidelines, principles and coding clinics to verify the appropriate ICD-10-CM, CPT codes modifiers, or DRG/APC for accurate coding assignment
- Working knowledge of entering audits into the database and use of medical records repository systems
- Associates degree from an accredited Health information Management program preferred
- Three to five years HCC auditing experience Graduate of an AHIMA or AAPC Certified Coding program
- Five years of coding experience in a health care setting
- Extensive knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures is required
- In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required
- The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential
- Excellent written and verbal communication skills are essential
- Proficiency in computer skills required for coding (MARS, Cerner)
- Detail oriented individual with excellent organizational skills
- Traveling may be required as necessary
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Quality Assurance Coding Specialist Resume Examples & Samples
- Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care to validate that the appropriate codes were assigned by the HCC Coding Specialist
- Ensure that all codes are documented for the assignment of a valid and accurate Hierarchical Condition Category (HCC)
- Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology
- Review the coding of diagnoses and verifying the proper ICD-9-CM codes were assigned by the HCC Coding Specialist
- Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure
- Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-9-CM and CPT codes were assigned including modifiers for correct DRG/APC assignment and accurate reimbursement
- Graduate of an approved Health Record Administration or Accredited Medical Record Technician program (RHIA/RHIT or eligible) or a certified coding program
- Extensive knowledge of ICD-9 and 10 and CPT classifications and coding of diagnoses and procedures is required
- Bachelors Degree or equivalent education/experience
- Three years of claims and/or general auditing experience preferred
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Quality Assurance Coding Specialist Resume Examples & Samples
- Utilize standard coding guidelines, principles and coding clinics to verify the appropriate ICD-9 and 10 CM, CPT codes modifiers, or DRG/APC for accurate coding assignment
- Threeto five years HCC and/or auditing experience
- Graduate of an AHIMA or AAPC Certified Coding program
- Extensive knowledge of ICD-9 and 10 and CPT classifications and coding of diagnoses and procedures is required. ]
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Coding Specialist, Certified Resume Examples & Samples
- Primary Care
- Infectious Disease
- Neurosurgery
- Plastics
- OB/Gyn
- Lab/Pathology
- And more…
- Revenue Capture
- Ensures all services provided are accurately captured in the medical record and billed appropriately. This is accomplished using the following methods
- One-on-one chart review with each provider
- In-depth understanding of EMR in the areas of charting tools (i.e. order entry, smart sets, etc...), charge dropping, and charge update, Charge review work-queues
- A review of each provider’s individual charting tools and preference lists to ensure accurate CPT, HCPCS and ICD-9/ICD-10 coding
- Investigation into supplies and medications dispensed at each clinic and a review of appropriate billing for them
- Working all CCI/LMRP edits, claims manager rules and other coding associated charge review WQ rules for each clinic or department supported
- The ability to provide feedback to each provider based on identified coding trends
- Maintains a current knowledge of regulations and legislation regarding billing compliance issues
- Denial Management
- Working all coding related denials
- Working all coding related patient complaints
- The ability to provide feedback to each provider based on identified denial trends
- Implement changes and provide education & feedback to providers, departments and clinics with regards to denials that impact revenue flow and or capture
- Provider Education
- Provides coding education (HCPCS, ICD-9-CM/ICD-10, DSM3-R, & CPT) to providers and clinical staff in accordance to the established corporate compliance plan
- Works with the Education & Compliance Specialist to further support and educate providers on their performance in the Provider Monitoring Program
- When provider documentation issues are identified, work with clinic management and the Education & Compliance Specialist (ECS) staff to implement corrective action plans
- Actively train physicians and other providers on coding and reimbursement issues. Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit
- The RCS will be responsible for implementing corrective action plans to improve revenue cycle outcomes. This may include (but not limited to) creating site-specific education, partnering with Revenue Services staff to implement site-specific revenue improvement projects, understanding how to leverage Epic technology to create revenue capture solutions, or suggesting operational changes at each location
- Certified Professional Coder (AAPC) or Certified Coding Specialist certification (AHIMA)
- Must have strong E/M coding experience
- Four year college degree or equivalent work experience
- 1+ years of experience as a certified coding specialist
- Three years demonstrated knowledge of coding
- Ability to present information in one-on-one and group settings
- Ability to communicate information in a professional and confident manner
- Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice
- Demonstrated ability in critical thinking, self-initiative, and self direction
- Understanding of physiology, medical terminology, and disease process is required
- Must understand and be able to apply the following regulations
- CMS Evaluation and Management Documentation Guidelines
- CMS Teaching Physician Guidelines
- CMS Correct Coding Initiative
- Third Party Payer Reimbursement Policies and Procedures
- Five years working with coding systems
- Two years previous experience in medical record chart documentation review
- Two years’ experience in group education with provider audiences
- One year working with EpicCare
- Two years working in a physician practice setting
- Demonstrated PC skills in Word, Excel, and Microsoft Access
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RN Coding Specialist Resume Examples & Samples
- Reviews claim files and medical records to code pertinent data using CRICO-RMF coding taxonomy in combination with ICD-9 classification
- Creates a comprehensive clinical narrative of the care provided in each case reviewed
- Identifies contributing factors related to the claim and care rendered
- Reviews complex medical, legal and consult services
- Works with manager reviewing client information needs and requests
- Provides expertise on healthcare organizations/providers, clinical risk management, safety, regulatory requirements and healthcare quality and accreditation functions
- Assists on additional PL projects as necessary
- Broad knowledge of healthcare organizations/providers, clinical risk management, safety, regulatory requirements, and health care quality and accreditation functions
- Good analytical and interpretive skills
- Strong organizational skills; detail oriented
- Good judgment and discretionary skills
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Senior Coding Specialist Resume Examples & Samples
- Reviews and analyzes patient medical records in providers’ offices or remotely. Ensures the records have been appropriately ICD - 10 coded to the highest level of specificity
- Assists in the processing of attestations from providers to review for compliant and accurate documentation of current HCC conditions
- Educates physicians, office staff, billers on CMS - HCC risk adjustment model, CDPS risk adjustment model, ACO risk adjustment model and how to utilize available reports and tools, and other related projects and initiatives
- Responsible for administrative duties related to planning, scheduling, and conducting coding audits with physicians
- Assists internal and external departments with billing and coding questions as well as risk adjustment related questions
- High school education or GED
- Coding certification (CCS or CPC through AHIMA / AAPC
- 4 or more years ICD - 9 / 10 hands on coding experience - preferably in a managed care setting
- MS office - Word / Excel
- Ability to travel 20% to local physician offices for education / training
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Revenue Management Coding Specialist Resume Examples & Samples
- Monitors changes made to the Charge Description Master
- Reviews and studies all information from third-party payors on claims filing, coding, and the adjudication process
- Studies, reports, and makes recommendations regarding compliance concerns
- Works with coding personnel to ensure that codes on the CDM are accurate and current
- Works with Information Systems personnel to make certain the CDM information is placed correctly in the system
- Analyzes revenue and reimbursement data to maximize financial improvement opportunities
- Oversees maintenance of VitalWare and Zirmed compliance tools and reporting
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CMT Administrative Coding Specialist Lead Resume Examples & Samples
- Code validate regional/national requests for Kaiser Permanente Health Connect® clinical Diagnosis and Procedures
- For ICD-9-CM, ICD-10-CM, CPT, and HCPCS code systems
- Code Validate government mandated regulatory updates, SOX compliance requests, audit and CMT QA projects for
- KP Health Connect Clinical Diagnosis and Procedures Master Files
- Co-chair Inter-Regional Coding Forum [includes preparation through facilitation and documentation]
- Participate in code validation related meetings with KP Health Connect business partners
- Maintain certified coding credential(s) through industry related continuing education seminars,
- Video conferences, webinars, HIMS association events, etc
- Document and enhance departmental workflow and process documentation
- Demonstrate ability to understand, utilize and apply the methods, principles, practices and techniques related to coding
- Of health information data. Demonstrate leadership experience with results-oriented approach; must excel in a
- Collaborate and consensus building Environment. Demonstrate ability to interact with diverse groups at all levels
- Of the organization and must have excellent communication & presentation skills (written and verbal)
- Demonstrate ability to work in a team environment, build effective teams & motivated self-starter
- Demonstrate ability to respond to detailed coding questions
- Certification from established HIM industry organization in ICD-9-CM, ICD-10-CM, CPT, and HCPCS is required
- Such as CCS (Certified Coding Specialist) and AHIMA-approved ICD-10-CM/PCS Trainer
- Individual is a seasoned senior-level professional experienced in all aspects of administrative code validation with
- Expertise in ICD-9-CM, ICD-10-CM, CPT and HCPCS code systems
- Must be able to function independently with minimal oversight and direction, facilitate improvements to existing
- Regulatory and QA projects/processes, and collaborate with regional partners in code validation mapping
- Able to review and prioritize business partner requests to complete code validation process utilizing
- ICD-9-CM, ICD-10-CM, CPT, and HCPCS code systems
- Able to perform analysis of business processes and functional requirements, development of business cases,
- And provide client support
- Must have working knowledge of MS Excel, Word, PowerPoint, and 3M/ electronic encoder application
- Bachelor’s Degree in a relevant discipline or 4 additional years of relevant experience is preferred
- Complete knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding systems
- General knowledge of billing guidelines
- Current certified coding credential from AHIMA and/or AAPC and ICD-10 trainer
- Knowledge of KP Health Connect diagnosis [EDG], procedures [EAP] and Op Time [ORP] Master Files is preferred
- Experience with inpatient hospital coding is preferred
- Successful in interacting and communicating with KP team members and customers to facilitate problem
- Resolution or information exchange
- Possess strong behaviors such as: building strong partnerships with others, team & service oriented, has ability to deal
- With ambiguity and conflict with minimal guidance, embrace learning and change, great collaborator, accountable,
- Focused, possess effective communication skills and determined to be compliant and do the right thing
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Physician Coding Specialist Resume Examples & Samples
- Certification in coding (CPC, COC, CCS, CCS-P, RHIA, RHIT)
- Formal training in CPT and ICD coding or previous work experience utilizing ICD and CPT coding principles is required
- Computer literacy and the ability to navigate multiple systems is required
- Ability to analyze, interpret and assimilate information from various sources based on technical and experience-based knowledge
- Comprehensive knowledge of procedure and diagnostic coding for professional services and Medicare, Medicaid and other 3rd party payer coding and billing regulations
- Queries physicians when code assignments are not straightforward or documentation in the
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Coding Specialist Resume Examples & Samples
- Navigates the electronic patient health record and other computer systems in determination of diagnoses and procedures to be coded
- Codes complex outpatient and/or emergency/urgent care patient care records utilizing encoder software in the assignment of ICD 10 CM, CPT-4, and HCPCS codes. Assigns coding in accordance with AHA Coding Clinic, AHIMA's Standards of Ethical Coding, a s well as URO/MO established coding guidelines. Obtains clarification in clinical documentation by querying providers
- Maintains up to date knowledge of changes in coding guidelines and regulations. Participates in educational opportunities to enhance knowledge in coding and reimbursement systems. Obtains/maintains certification from AHIMA to validate coding
- Skills
- Maintains working knowledge of applicable Federal, State, and local laws and regulations, the Organizational Integrity program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects hones, ethical, and professional behavior
- High School diploma or equivalent required
- Licensure / Certification: Certification eligible (CCA, CCS, CCS-P, CPC (recognized by Association Academy of Professional Coders), RHIT, RHIA)
- One year of hospital based outpatient coding experience is required
- Experience utilizing coding/grouping software with emphasis on CPT-4 coding is required
- Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job
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Clinical Document Coding Specialist Resume Examples & Samples
- Educates clinicians on MS-DRG methodology as it relates to documentation initiatives
- Works closely with physicians and physician advisor to ICD-9-CM coding accuracy and documentation completeness in order to optimize reimbursement
- Tracks and trends opportunities for physician education and reports recommendations monthly to Director Case Management
- Tracks results of the program monthly using “best practice” monitors developed
- Attends HIM coding meetings and meets requirements for HCA inpatient coders
- Periodically reviews ATLAS for newly added coding regulations/information and clinical documentation team information
- Conducts initial and extended-stay concurrent reviews on all selected admissions, and documents findings on DRG worksheets, denoting all key information utilized in the tracking process
- Utilizes inpatient admission criteria to assign only diagnoses that meet acute care criteria
- Performs thorough chart reviews to ensure co-morbidities/complications are documented appropriately
- Collaborates with physician, physician extender, nurse, case manager/utilization reviewer and Medical Records coder to identify principal diagnosis options, secondary diagnoses and procedures, to assign working DRGs for at least 80-85% of identified populations
- Works collaboratively with the healthcare team to facilitate documentation within the medical record that supports patient’s severity of illness and risk of mortality i.e. identifies need to clarify documentation in records, and utilizes strong communication skills with physician, physician extender, case manager, utilization reviewer, nurse or other healthcare professionals, utilizing appropriate tools to capture needed documentation
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Billing & Certified Coding Specialist Resume Examples & Samples
- Responsible for performing specialty coding for services and medical office visits
- Compares and reviews charge tickets, both manually and system generated, to clinical documentation to ensure that all charges for procedures and pharmacy items have been accurately documented and captured
- Ensures that documentation supports charges to prevent denials/underpayments
- Follows-up on missing charge tickets and clinical documentation as appropriate
- Assist with implementation of documentation and revenue enhancement opportunities
- In conjunction with Sr. Billing Analyst, identify relevant charge master or fee updates
- Responsible for resolving any coding related errors and denials that are identified by Hospital or Practice billing system as part of the revenue enhancement initiatives
- Consults and provides feedback with frontline clinical staff and financial coordinators to identify reimbursable indications for treatment
- Assists on reviews of revenue cycle with management and supervisor
- Participates in education programs to maintain up to date coding skills
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Claims Coding Specialist, Senior Resume Examples & Samples
- Intermediate ability to quickly research and absorb new payment systems
- Intermediate other knowledge of Medicare and Medicaid payment systems
- Required strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
- Required advanced level of other billing expertise in UB92, UB04, HCFA 1500 and other healthcare services
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Coding Specialist Auditor Resume Examples & Samples
- Audit medical record documentation to identify undercoded and upcoded services
- Communicate effectively with internal staff
- Compile and report statistical data to internal staff
- Completion of special projects including claims and/or coding related audit support
- Ensures strict confidentiality of all records
- Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology
- Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, emergency room record to accurately assign a diagnosis and / or procedure
- Under direct supervision prepares detailed audit assessments and reports with recommendations and shares to appropriate internal and external customers in a timely manner
- Under direct supervision provides a second level review of coding to ensure compliance with legal procedural policies and to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices
- Under direct supervision provides general assistance to other departments as requested
- Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-10 CM and CPT codes were assigned including modifiers for APC assignment and accurate reimbursement
- Certification in Infection Control or Certified Coding Specialist or Certified Professional Coder or Registered Health Information Administrator or Registered Health Information Technician
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Clinical Coding Specialist CCS Resume Examples & Samples
- Thoroughly reviews entire patient medical record documentation to substantiate diagnoses and procedures and statistical data
- Applies UHDDS to select the principal diagnosis, procedures, complications and co-morbidities
- Accurately codes the inpatient and ambulatory surgery records in accordance with established ICD-10-CM and CPT coding guidelines
- Reviews medical record to confirms or update assignment of attending physician, clinical service, consultants and discharge disposition
- Accurately abstracts and enters coded clinical and hospital data into the automated coding/abstracting system
- Reviews and verifies final DRG or APC assigned by grouper
- Questions and investigates, as appropriate, conflicting documentation in the record to obtain most accurate information for coding and abstracting. Contacts appropriate physician for clarification as directed
- Demonstrates understanding and working knowledge of ICD and CPT coding
- Maintains technical competence with best coding practices by reviewing updated clinical information resources, i.e. AHA coding clinic, APC assistant
- Achieves and maintains a level of performance in accordance with quality and productivity and timeliness work standards
- Maintains confidentiality of all protected health information (PHI); refrains from discussing PHI unless it is necessary to carry-out job duties. In all cases uses discretion and a low tone of voice if PHI is discussed
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Coding Specialist Resume Examples & Samples
- Abstracts pertinent information from patient records
- Assigns the International Classification of Diseases, Clinical Modification (ICD), Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, creating Ambulatory Patient Classification (APC) or Diagnosis-Related Group (DRG) assignments
- Obtains acceptable productivity/quality rates as defined per coding policy
- Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
- Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements
- Performs other duties as assigned by Coding Manager
- HS or Equivalent
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Corporate Coding Specialist Resume Examples & Samples
- Associate’s degree in Health Information Management and certification as a Registered Health Information Technician (RHIT); or
- Associate’s degree and certification as a Certified Professional Coder (CPC); or
- Currently enrolled in an accredited Health Information Management program with at least 45 credit hours towards an Associate’s degree and the equivalent of six (6) months of related experience*; or
- High School diploma or G.E.D. and the equivalent of two (2) years of full-time related experience and certification as a Certified Professional Coder (CPC)
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Coding Specialist, Behavioral Health Resume Examples & Samples
- Certified Professional Coder (AAPC) or Certified Coding Specialist certification (AHIMA)
- Three years demonstrated knowledge of coding
- Four year college degree or equivalent work experience
- Ability to present information in one-on-one and group settings
- Ability to communicate information in a professional and confident manner
- Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice
- Demonstrated ability in critical thinking, self initiative, and self direction
- Understanding of physiology, medical terminology, and disease process is required
- Must understand and be able to apply the following regulations
- CMS Evaluation and Management Documentation Guidelines
- CMS Teaching Physician Guidelines
- CMS Correct Coding Initiative
- Third Party Payer Reimbursement Policies and Procedures
- Five years working with coding systems
- Two years previous experience in medical record chart documentation review
- Two years’ experience in group education with provider audiences
- One year working with EpicCare
- Two years working in a physician practice setting
- Demonstrated PC skills in Word, Excel, and Microsoft Access
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Certified Procedural Coding Specialist Resume Examples & Samples
- Examines documentation to match appropriate codes with patient record for medical necessity
- Reviews patient eligibility and benefits, and obtains prior authorization for medications
- Communicates effectively between patients, providers, and payers
- Periodically reports to management on all revenue cycle matters involving registration, scheduling, eligibility, benefits, ABNs, pre-certification service, e-bill, and charge capture
- Attends required hours of training and/or in-services
- Participates in the orientation and/or training of new staff
- Participates in annual educational needs assessment
- Maintains required job skill competencies and completes skill assessment annually
- Completes and maintains documentation of continuing education hours annually
- CPC – Certified Procedural Coder
- CPC-H – Certified Procedural Coder-Hospital
- CCS – Certified Coding Specialist
- CCS-P – Certified Coding Specialist-Physician
- Knowledge of medical terminology, anatomy and physiology and basic principles of coding is required
- Formal training in ICD-9-CM and CPT coding classification systems and/or experience coding in a clinic setting desired
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Certified Procedural Coding Specialist Resume Examples & Samples
- Assesses the adequacy of the health record documentation to ensure it supports all diagnoses and procedures to which codes are assigned
- Apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures
- Maintain understanding of ICD-10 and CPT coding classification systems
- Review and perform data charge entry to both hospital and physician patient accounting systems for the outpatient clinic visit
- Assign both ICD-10 and CPT codes at the hospital level
- Review and perform data charge entry to both hospital and physician outpatient accounting systems for the outpatient
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Certified Procedural Coding Specialist Resume Examples & Samples
- Reviews and selects appropriate ICD-10 and CPT codes; CPT coding in this position is coding surgeries in the inpatient, observation, and day surgery suites
- Reviews and performs charge data entry to both hospital and physician patient accounting systems and consults with other coding staff, nursing units, case management staff, physicians, clinics and hospital personnel
- Reviews documentation to match appropriate codes with documentation for medical necessity
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Certified Procedural Coding Specialist Resume Examples & Samples
- Codes or adjusts codes on a variety of patient accounts, referred from other areas within HBS or bolt-on systems
- Processes errors on a daily basis and reports any backlogs to management on a weekly basis. Meets departmental productivity standards on a regular basis
- Contacts HIM regularly to resolve coding issues which impact bill generation and/or payment
- Works closely with the unit nurse to resolve as many coding concerns as possible, before contacting other UAMS departments
- Contact outpatient clinical areas, where necessary to clarify coding-related issues in documentation
- Works with the research areas to clarify gaps between services rendered and the research budget
- Acts as a resource within HBS on all coding issues, regardless of the status of the account: pre-bill, billing or collection
- Completes required education to retain certification
- Remain familiar with all regulations regarding coding and coding quality that are published for the entire organization by the Director of Health Information Management
- Builds clinical trial/research billing calendars in POC
- Reviews clinical trial charges and claims to ensure appropriate billing
- Reviews bone marrow accounts for correct billing
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Coding Specialist, Office Based Resume Examples & Samples
- Current CPC, COC, CCA, CCS-P, CCS, or RHIT Coding Certification
- Ideally, 1 or more years of coding general surgery, pain management services, ob/gyn, gynecological oncology, or perinatal services; though we will consider anyone with an active AAPC or AHIMA Certification (listed above) if you pass our interview and coding assessment
- You need to know how to read a record and evaluate and code E/Ms and procedures from general surgery, pain management or perinatology charts to bill the correct charges on a Superbill
53
Coding Specialist Resume Examples & Samples
- Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate's degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor's degree in Health Information Management (HIM) or related healthcare field is preferred
- Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required
- Two years of current acute care coding emergency department and observation or physician coding experience is required
- Current experience utilizing encoding/grouping software or CAC is preferred. Ability to utilize both manual and automated versions of the ICD and CPT coding classification systems is preferred
- Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable
54
Coding Specialist Resume Examples & Samples
- Prefer an Associate’s Degree or equivalent technical school completion of a certified coding program and 2 to 3 years related coding experience. Will consider applicants with relevant education and/or experience
- Certified Coding Specialist - AHIMA (CCS) or Certified Professional Coder - AAPC (CPC) preferred. RHIA or RHIT credentials will also be considered. If applicant has no coding certification, CPC certification must be obtained within 12 months of hire
- 2 to 3 years ICD-9-CM and CPT coding experience performing clinic and hospital based inpatient and outpatient coding for professional billing
- Demonstrated ability to code accurately and apply coding guidelines and conventions on all cases
- Knowledge of healthcare billing and reimbursement including industry standard billing rules, Medicare, Medicaid, L&I, and commercial insurance
- Performs well on coding assessment and is able to explain rationale for assignment of codes
- Knowledge of coding principles. Ability to identify and solicit documentation to code the complete clinical picture based on knowledge of disease processes, clinical judgment, and interaction with medical staff
- Knowledge of anatomy and physiology, medical science, and medical terminology
- Ability to develop and maintain good working relationships with peers, physicians, and other staff members
- Ability to share coding knowledge with peers and other disciplines throughout the organization
- Strong analytical, problem solving and communication skills required
- Ability to work in a high volume environment while maintaining high quality standards
- Demonstrated literacy in the use of personal computers and Windows applications required. Excellent written/oral communication, ability to manage, set priorities, and operate with minimal direct supervision
- Some presentation/speaking skills are preferred
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Coding Specialist, Radiology Resume Examples & Samples
- Current CPC, COC, CCA, CCS, or RHIT Coding Certification or willing to get it within 6 months of employment
- If Certified, 3+ years of Radiology and ICD10 coding experience in a high production environment
- If not Certified, 6+ years of Radiology and ICD10 coding experience in a high production environment
- Diagnostic Radiology coding or Vascular Interventional Radiology coding experience are both a big plus
- Knowledge of anatomy and medical terminology
- Proficiency in MS Word and MS Excel, and DX knowledgeable
- Analytical mindset, with great attention to detail
- Self-motivated, with proven ability to code with speed and accuracy
- Solid verbal and written communication skills
- Team player with great interpersonal skills
- High School Diploma or General Education Degree (GED) and experience as detailed above and below
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Professional Fee Physician Office Coding Specialist Resume Examples & Samples
- Reviews, interprets and verifies evaluation and management (E&M) and other CPT-4 procedural codes according to the physician's documented office visit notes, orders, hospital notes and other pertinent physician documentation loaded in the medical record (CodeRyte CAC)
- Utilizes CodeRyte CAC to accurately code diagnoses based on the physician's documented diagnosis
- Identifies and codes global services and/or appropriate concurrent services according to coding guidelines, and applies correct modifiers
- Corrects codes that have been assigned by physician practices to ensure data and codes are consistent w/ ICD-9-CM/ICD-10 CM Official Guidelines, CPT, CPT Assistant, and CMS
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Certified Procedural Coding Specialist Resume Examples & Samples
- Establishs Clinic protocols and work flow within the compliance frameworks as established by CMS
- Ensures that clinic charges are coded accurately based upon review or EMR documentation and that discrepancies are resolved between clinical documentation and EMR clinical order system
- Works with faculty and residents to ensure that coding protocols are followed in clinical documentation, audits EMR record to ensure accuracy of all demographic, coding and charge data
- Audits the accuracy of ICD-10 coding and CPT coding periodically to ensure that all clinic visits and procedures are coded accurately
- Assembles lists of the most common errors (coding, billing and documentation) onto a spreadsheet detailing the DOS, patient’s name, responsible provider/nurse, and problem and present at the monthly practice management conference
- Provides coding issue information to Residency Director, Medical Director, Business Manager, and Billing Manger biweekly
- Reviews all old EMR documents that are over seven (7) business days delinquent
- Assigns diagnosis and procedure codes for each patient encounter, conforming to ICD-10-CM and CPT guidelines
- Sends flags to resident/faculty advising them of delinquent charts and advises faculty mentor of non-compliance for completion of charts
- Provides resident and faculty education for coding and compliance and assists the Practice Administrator and the Residency Program Director in the development of a curriculum for coding and compliance, audits to ensure that the deadline for completing EMR is adhered to by all providers, and leads monthly noon conferences with Faculty/Residents per the coding/compliance curriculum and assists the Compliance Office Manager in annual HIPAA training for Residents/Faculty
- Prepares and presents coding problems and solution once a month at noon conference
- Keeps abreast of changing Medicaid, Medicare, and third party insurance carrier requirements relative to CPT coding
- Utilizes ICD-10 and ICD-10 coding skills in order to apply diagnoses correctly as they relate to CPT codes and Medicaid, Medicare, and third party payer requirements
- High School Diploma/GED plus two (2) years CPT and ICD-9 coding experience required
- CPC certification
- Knowledge in basic medical terminology
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Medical Billing & Coding Specialist Resume Examples & Samples
- Effectively and efficiently work with ICD-10, CPT, and HCPCS reference books for proper billing
- Code ICD-10 diagnoses, link appropriate diagnoses with CPT procedure codes, and correct any incorrect coding by provider
- Utilize acute knowledge of HCC coding specificity requirements to perform medical chart reviews and identify missed or erroneous HCC coding
- File electronic claims within 48-72 hours of entry
- Provide feedback query (sendbacks) to providers in instances of coding-related problems
- Work with insurance and data entry for accuracy with billing and data entry problems
- Assist providers and clinician staff with billing problems and concerns
- Maintain strict confidentiality
- Demonstrate and exemplify behavior consistent with DaVita’s core values – service excellence, integrity, team, continuous improvement, accountability, fulfillment, fun
- Attend assigned meetings or functions as specified by supervisor
- Maintain knowledge of company policies and procedures, OSHA and other related regulations and guidelines, and ensure department compliance
- Attend and complete all required training and development to include annual compliance training
- Assist with special projects and other duties as assigned
- Dedication, above all, to caring for patients suffering from chronic kidney failure across the nation
- Minimum: 2+ years of experience in claims processing or provider configuration
- Preferred: Medical audit experience
- Preferred: Experience with ICD9/10 codes, CPT codes, HCC coding, Medicare Advantage contracts and/or financial analysis
- Knowledge of healthcare reimbursement/delivery
- Knowledge of electronic medical records/billing systems and medical terminology and abbreviations
- Decision making ability that requires the use of considerable judgment in the analysis of data and the problems/errors resulting from the analysis
- Demonstrated proficiency in MS Excel and Word
- Possess high accuracy, efficiency, and dependability
- Possess strong organizational skills
- Communicate effectively, establish and maintain an effective working relationship within other areas of the organization
- Ability to work in fast paced environment with changing priorities
- Associates degree in related field preferred
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Physician Services Coding Specialist Resume Examples & Samples
- Assign ICD-10, CPT-4 and HCPC codes from documentation
- Uphold productivity standards and daily quota set by management
- Mentor and assist in new employee training
- CPC or CCS-P or equivalent certification, additional specialty certifications a plus
- Ability to understand and follow compliance issues of difficult complexity by utilizing appropriate coding and compliance resources
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Physician Services Coding Specialist Resume Examples & Samples
- Locate and understand Medicare CCI, LCD edits
- Uphold productivity standards set by management
- Present coding issues to internal or external clients, when necessary
- Meet deadlines and complete assignments before monthly closing date
- CPC, CPC-A or CCS-P or equivalent certification
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Coding Specialist Auditor Resume Examples & Samples
- Prepares detailed audit assessments and reports with recommendations and shares to appropriate internal and external customers in a timely manner
- Provide assistance to other departments as requested
- Provides a second level review of coding to ensure compliance with legal procedural policies and to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices
- Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure
- Under direct supervision assist with the development and maintenance of policies, standards and procedures
- Under general supervision researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services
