Nationwide Children's Hospital

  • Coding Specialist - Professional Billing

    Posted Date 1 week ago(5/14/2018 2:41 PM)
    Requisition ID
    2018-11724
    Category
    Registration/Billing
  • Overview

    The moment you walk through our doors, you can feel it. When you meet one of our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it, too. Welcome to Nationwide Children’s Hospital, where Passion Meets Purpose.

    Here, Everyone Matters. We’re 12,000 strong. And it takes every single one of us to improve the lives of the kids we care for, and the kids from around the world we’ll never even meet. Kids who are living healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

    Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

    Nationwide Children’s Hospital. A Place to Be Proud.


     

    The Coding Specialist is responsible for analysis and review of professional medical records; accurate coding and abstracting professional medical records for the purpose of reimbursement, research and compliance with federal regulations by diagnosis, assignment of ICD-9 and CPT codes for inpatient and outpatient medical services as indicated.

     

    Also responsible for researching newly identified diagnoses and/or procedures for code assignments and performing related miscellaneous duties as assigned.

    Responsibilities

    • Utilizing 3M, CPT, and ICD-9-CM coding books assigns CPT and ICD-9-CM codes to medical services or charges.
    • Perform charge reconciliations to ensure all charges are being captured.
    • Conducts ongoing and sample chart reviews of providers to assure coding accuracy and to identify missed coding opportunities.
    • Maintains updated knowledge of coding requirements; including continuing education and certification renewal.
    • Reviews and performs necessary coding and billing corrections for all insurance coding and medical necessity denials.
    • Assists the billing staff with coding questions.
    • Consistently meets the department specific standards for quantity standard.
    • Consistently codes 95% accuracy rate or better (quality standard).
    • Utilizes Internet and other resources to research newly identified diagnosis and/or other procedures.
    • Assists physicians by identifying the necessary ranges of disease or procedure codes.
    • Researches CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
    • Acts as a liaison between the physicians, parents and third party payers in resolving billing and reimbursement accuracy.
    • Conduct billing and coding compliance audits, which may include review of in-patient and out-patient medical records to determine appropriateness of documentation, procedure and diagnosis coding, and evaluation and management coding.
    • Conduct analysis and be able to apply state and federal healthcare or related regulations to different questions, projects or inquiries.
    • Conduct coding and billing education sessions with the practitioners and other staff who may be involved in coding and billing.
    • Handle inquiries from the Department's customers on billing and coding compliance-related questions.
    • Utilize a standardized audit tool or tools for all audits.
    • Create and utilize a standard audit finding report for communicating the results of the audits in a clear, concise manner.
    • Performs other duties as assigned.

    Qualifications

    KNOWLEDGE , SKILLS AND ABILITIES REQUIRED

    • High school diploma or equivalent
    • CPC or CCS-P Certification required
    • Good working knowledge of medical terminology and anatomy
    • Must possess high degree of professional competency for coding, accuracy in all details, and must possess a self directed work ethic.
    • Strong problem-solving, collaboration and interpersonal skills
    • Ability to work effectively and professionally under pressure
    • Ability to maintain and establish strong working relationships with physicians and support staff
    • Intermediary skills in MS Office: Word, Excel and Outlook required
    • Previous Professional coding experience (5+ years) with documented education in anatomy, physiology, and medical terminology required. Pediatric coding and billing a plus.
    • Ability to handle multiple tasks and priorities and deadlines.
    • Analytical and organizational skills a must for analyzing clinical information and data
    • Effective communication and interpersonal skills required with ability to work with physicians and other caregivers regarding coding issues.

     

    MINIMUM PHYSICAL REQUIREMENTS

     

    Sitting Constantly 67-100%

    Typing on a keyboard Frequently 34-66%

    Standing/Walking Occasionally 0-33%

    Able to independently lift up to 25lbs Occasionally 0-33%

     

    The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

     

    EOE M/F/Disability/Vet

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