Coding Specialist

General Scope:   Responsible for accurately assigning CPT, HCPCS, ICD-10-CM and modifier codes while adhering to federal and local regulations (CMS, CPT/AMA, NCCI).

 

Duties and Responsibilities:

  • Proficiency in coding Diagnostic Radiology; ED, IP, OP
  • IVR coding experience preferred; particularly experience with complex interventional coding (e.g., CVC, PICC, arterial and vascular procedures, embolization, diagnostic angiograms, etc.)
  • Proficiency with E/M coding guidelines
  • Collaborate with the Imaging Authorization team to provide pre-determination for PET services and confirm medical necessity guidelines are met prior to scheduling
  • Ensure that report dictation meets QPP MIPS and internal metric specifications
  • Support the ‘Fee Line’ call group to provide out-of-pocket estimates based on CPT coding and payer reimbursement tools
  • Review and resolve coding ‘exception flags’ prior to claims submission; LCD/NCD edits
  • Assist with resolution of coding-related denials and appeals; ability to identify denial trends and make recommendations for resolution
  • Aid in monthly QC audits to ensure coding compliance with federal and local regulations
  • Participate in end of month balancing and reconciliation procedures
  • Assist in the development of department documentation for all coding and appeal processes
  • Maintains strictest confidentiality; adheres to HIPAA policies and practices patient privacy standards

 

Other Coding Dept Related Support:

  • Respond to coding questions from staff while referencing viable resources, edits, and guidelines
  • Provide backup support for other department staff as needed
  • Look for opportunity. Where are we under/over coding?  Is there an opportunity to generate more revenue by altering our coding practices, while being compliant with regulations?
  • Performs special projects or other duties as assigned

 

Preferred Education and Experience:

  • Minimum of 3 years’ experience in radiology coding
  • RCC or equivalent; credentials or experience with Interventional Radiology coding a plus
  • EPIC and Optum360 experience a plus
  • Proficiency in MS products; Excel, Outlook, Word

 

Professional Characteristics:

  • Demonstrates accuracy and thoroughness
  • Exceptional organizational and time management skills
  • Ability to work independently with limited supervision
  • Motivated self-starter and commitment to continuous improvement
  • Comfortable asking questions, and comfortable accepting direction and feedback

 

Typical Physical Demands:

  • Requires prolonged sitting, some bending, stooping, and stretching
  • Manual dexterity sufficient to operate a keyboard and use of the telephone
  • Requires visual acuity adequate to examine patient charts and radiology reports; also, normal hearing and speaking to communicate clearly to patients and staff in person or over the telephone

 

Typical Working Conditions:

  • Normal office environment; or eligible for remote work with suitable working environment that meets HIPAA standards and allows for protection of PHI
  • Full-time (preferred) or Part-time; scheduled to work during normal business hours, 8:30am – 5:00pm PST
  • May be asked to work additional hours during end of month balancing procedures

Send resume to jobs@vrads.com