Coding Specialist - Clinic F/T Day

Prisma Health
United States, South Carolina, Seneca
Jan 03, 2025
Inspire health. Serve with compassion. Be the difference. Job Summary Reads and abstracts data from inpatient, observation records and patient records. Assigns diagnosis and procedure codes based on current regulations and coding guidelines. Essential Functions Validate ICD-9 and CPT codes for compatibility and medical necessity for services performed by Prisma Health physicians and or practices, while utilizing the correct coding initiative to ensure minimal coding errors and rejections through Claims Manager and the Test Edit process. Maintain coding and documentation compliance through the practice documentation compliance process. Providing feed back to the practices to ensure correct coding and documentation compliance based on Medicaid/Medicare and federal teaching guidelines.40% Process Claims rejection reports and Med-assets reports weekly as well as Interact w/collectors and AR staff in analyzing claim rejections by all carriers to improve and correct coding related reimbursement issues. Reviews 97 rejection report to capture possible auto adjustment errors for revenue capture. Work with A/R collection staff by writing up charge corrections for billing corrected claims from this report. 40% Participate in coding and educational meetings in order to maintain coding accuracy and compliance w/physicians, practices, business offices, Med-assets group, Test Edit committee, or staff as well as management. Maintains and enhances current knowledge of billing and coding practices at meetings and seminars, study of reference material and updates to coding manuals. Meets with management and practice staff to discuss billing and reimbursement issues and changes for the purpose of improving departmental billing and reimbursement processes. Reviews newsletters, notices and updates to coding manuals to maintain current knowledge of applicable billing and coding practice and procedures. Make recommendations for change to departmental procedures in accordance with current practices and procedures. Attends meetings, conferences and seminars, as approved by department, to remain updated on latest billing procedures. Attends mandatory educational training sessions covering Prisma Health Compliance guidelines on an annual/regular basis. Maintains yearly CPC renewal and CEU requirements. 10% Provide coverage as needed/requested by supervisor to maintain department, billing and coding operations. Obtain Medical/Clinical and demographic information from ECW, Sovera, GE/IDX systems for coding process as well as outside sources such as Coding Q&A Medicaid and Medicare websites. Provide coding information and resolutions to physicians, practices, business office staff, accounts receivable and management on a daily basis. 10% Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent Experience - 2 years - Experience in physician inpatient/outpatient billing, coding, required. Knowledge of anatomy, physiology and medical terminology required. In Lieu Of N/A Required Certifications, Registrations, Licenses CPC - Preferred Knowledge, Skills and Abilities Work Shift Day (United States of America) Location Ctr For Family Med - Oconee Facility 1064 Oconee Memorial Hospital Department 10649198 CFM Administration Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.