Billing Coder

Department:  
Business Office 
Expected Weekly Hours:  
40 

Position Purpose:  

The Coding Specialist  reviews superbills and the corresponding medical record documentation and assigns appropriate CPT, HCPCS, modifiers,  and ICD 10 codes and post charges in order to achieve maximum reimbursement in accordance with OSNI protocols and procedures along with CMS and private payer guidelines. The core responsibilities will include: daily charge posting after assignment of appropriate billing and diagnostic codes, review of first level rejected claims in practice management, use of hospital portals to obtain operative reports and patient demographics, scanning of completed work into SRS  . Additional responsibilities include querying physicians and ancillary medical staff when medical record requires clarification, ensuring medical record is amended by provider when appropriate and participating in internal provider coding review sessions.  

Job Description Details:   

Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions.  
 
Performs all coding functions, including CPT/HCPCS and ICD 10 code assignment. Reviews medical record to ensure appropriate codes are utilized and documentation supports code use. Queries physicians and medical ancillary staff when necessary for clarification.  These functions will be in coordination with the Business Office team. . 
 
Utilizes available data and resources to make decisions regarding appropriate code assignment in accordance with state, federal, and payer guidelines:  
 

• Receives and reviews patient charts and documents for accuracy 
• Assigns appropriate CPT, HCPCS, ICD-10 codes along with appropriate modifiers to capture service rendered 
• Performs accurate charge data entry into practice management system 
• Reports missing data as required; 
• Queries physicians and medical staff when appropriate 
• Participates in internal provider coding review sessions 
• Reviews and corrects electronic first level claim rejections in practice management 
• Prints and mails paper claims with corresponding records as appropriate 
• Follows applicable coding guidelines and legal requirements to ensure compliance with federal and state regulations 
• Maintains thorough working knowledge of private payer guidelines 
• Remains apprised of changes to coding guidelines and code sets 
   

 
Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff, as required to clarify discrepancies, and obtain demographic and clinical information.  
 
May prepare special reports as directed by the Manager to document coding  
 
May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. Cross- training in various functions is expected to assist in the smooth delivery of departmental services.  
 
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, as well as OSNI’s Standards of Conduct, and other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

Other duties as needed and assigned by Billing Manager, Practice Manager, and/or CEO 

MINIMUM QUALIFICATIONS  

High school diploma or an equivalent combination of education and experience. RHIT, CPC, or CCS is required. Associate degree or higher in coding or  health information management, accounting or business administration highly desired. Data entry skills (50-60 keystrokes per minutes). Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing coding or billing functions is required. Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc), managed care contracts and coordination of benefits is required. Thorough working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are required.  
 
Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers. Accuracy, attentiveness to detail and time management skills are required.  
 
To successfully accomplish the essential job functions of this position, the incumbent will be required to work independently, read, write, and operate keyboard and telephone effectively. 
 
Must be comfortable operating in a collaborative, shared leadership environment. 
 
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of OSNI. 

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS  

Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem solving skills are essential.  
 
This position requires the ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.  
 
The greatest challenge in this position is to ensure that coding activities are performed promptly and in an accurate manner to assist in order to reduce potential financial loss to the patient and the OSNI. The incumbent must have a thorough knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient’s account.  
 
Position operates in an office environment. Work area is well-lit, temperature controlled and free from hazards. The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen. The noise level is low to moderate.  
 
Completion of regulatory/mandatory certifications and skills validation competencies preferred. 
 
Must possess the ability to comply with OSNI policies and procedures. 

OSNI’s Commitment to Diversity and Inclusion  

Because we serve diverse populations, OSNI colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. 
 
OSNI’s dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.