Overview

Outpatient Coding Specialist

The OP Coding Specialist is responsible for reviewing the office and hospital charges prior to billing to evaluate for accuracy using knowlege of hospital outpatient coding rules. Reviews denials in the Follow-Up work queues and updates insurance and demographic issues causing claim denials. Works collaboratively with team members to answer questions and/or resolve issues related to documentation, coding and billing of oncology servicesCommunicates with insurances carriers to resolve claims issues as well as work with Management to communicate system issues.  Navigate payer websites and follow proper telephone etiquette.Completes estimates for treatments  Responsibilities Assigns sequence (primary, secondary, etc.) according to coding guidelines and enters codes into the electronic system to provide data for billing and reimbursementUses appropriate diagnoses codes, CPT codes and modifiers in the coding of hospital outpatient oncology servicesThis position evaluates medical records and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines for technical Radiation Oncology and Medical Oncology servicesConsults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codesMaintains current knowledge of ICD diagnosis codes, CPT physician service codes, , and governmental (Medicare, Medicaid, TriCare), commercial and managed care regulations by reading relevant professional literature and by attending workshops and lecturesAccrues sufficient continuing education hours to maintain national coding certificationWorks collaboratively with team members to answer questions and/or resolve issues related to documentation, coding and billing of oncology servicesResolves pending charges in the Epic workqueuesWork all assigned billing edits related to radiation oncology technical and medical oncology within EMR.Performs other related duties incidental to the work described herein Qualifications

Qualifications:

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

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

Coding experience with Oncology and/or Primary Care preferred.

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