We are seeking a Coding Specialist III who will be responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Responsible for developing coding and billing change procedures. Responsible for training on all coding and billing changes.
Specific Duties & Responsibilities
Procedural Knowledge
- Responsible for all aspects of coding, quality assurance, and compliance with Federal payer documentation guidelines.
- Works closely the Office of Billing Quality Assurance to include review of documentation.
- Serves as departmental expert on coding questions.
- Exercises independent judgment and decision-making on a regular basis with respect to code selection.
- Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies.
- Researches and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
- Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
- Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
- Gathers and verifies all information required to produce a clean claim, including special billing procedures that may be defined by a payer or contract.
- Maintains a system of billing accuracy through encounter verification, i.e., clinic schedules, encounter forms, I/P consults, and medical records.
- Review and resolve Epic Charge Review Edits daily.
- May act as a backup to Charge Entry when needed.
- Pro Fee Tracking Database- May fill out the missing information form and forward it to the appropriate contact person.
- Works with Department Management to create Charge Review Rules to prevent unnecessary denials.
- Works with Department Management on maintenance of provider preference lists.
- Provides training on all coding changes to providers and staff. Develops presentations to effectively communicate how changes will affect provider billing and coding. Provide face-to-face training on changes to providers based at all Hopkins locations.
Technical Knowledge
- Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
- Working knowledge of JHU/ PBS Billing Applications.
- Utilize online resources to facilitate efficient claims processing.
- Capable of advanced problem-solving in medical billing and coding.
Professional & Personal Development
- Participate in ongoing educational activities.
- Assist in the training of staff, providers, management, and administration.
- Keep current of industry changes by reading assigned material on work-related topics and providing updates to providers, staff, management, and administration
- Complete three days of training annually.
Minimum Qualifications
- High School Diploma or graduation equivalent.
- Five years coding experience with demonstrated analytical skills.
- Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge.
- CPC certification.
- Specialty CPC certification or second AAPC certification.
- Experience with Medicare regulations.
- Understanding of third-party payer issues.
- Epic experience preferred.
- Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.
Classified Title: Coding Specialist III
Job Posting Title (Working Title): Coding Specialist III (Anesthesiology & Critical Care Medicine)
Role/Level/Range: ATO 40/E/03/OG
Starting Salary Range: $24.25 - $42.50 HRLY ($63,000 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Monday-Friday (8 hours)
FLSA Status: Non-Exempt
Location: Remote
Department name: SOM Ane Production Unit Billing
Personnel area: School of Medicine
