We are seeking a Coding Specialist responsible for diagnosis and CPT coding within the various department billing offices. Will review or code charges for diagnosis and CPT for entry into the JHM and JHU/ PBS billing applications. This can be accomplished through an interface or manual charge entry for services performed at JHM practice sites.
Specific Duties & Responsibilities
- Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
- Bundle appropriately based on CPT code rule and payer billing guidelines.
- Resolves POS vs. CPT code discrepancies.
- Verify E/M code type such as New vs. Establish patients and level of service.
- Responsible for maintaining a system of billing accuracy through encounter verification i.e., clinic schedules, encounter information in EPIC, I/P consults and medical records.
- Follows payer guidelines.
- Follows limiting coverage guidelines for diagnosis coding by using LCD/NCD/payer policy information and assigns appropriate modifiers based on departmental policy.
- Carries diagnosis code out to the highest level of specificity that is appropriate.
- Follows ICD-10 codes to ensure diagnosis codes are appropriate for each specialty.
- Review and resolve EPIC Charge Review edits daily.
- May obtain correct NPI number and all needed information from Referring Doc Dictionary. May act as a back up to Charge Entry when needed.
- Will research and respond to coding questions from physicians, patients (via SBO Account WQ) and co-workers as necessary.
- Exercises independent judgment in daily activities.
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.
Professional & Personal Development
- Participate in on-going educational activities.
- Assist in the training of staff.
- Keep current of industry changes by reading assigned material on work related topics.
- Complete three days of training annually.
Service Excellence
- Must adhere to Service Excellence Standards.
- Customer Relations
- Self-Management
- Teamwork
- Communications
- Ownership/Accountability
- Continuous Performance Improvement.
Minimum Qualifications
- High School Diploma/GED. Medical Terminology, Anatomy, and Physiology courses or demonstrated appropriate knowledge. CPC Certification (or department approved certification).
- One-year related experience in medical billing and demonstrated analytical skills.
- Additional education may substitute for required experience and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.
Preferred Qualifications
- Epic experience.
- Understanding of third-party payer issues.
Classified Title: Coding Specialist
Role/Level/Range: ATO 40/E/02/OE
Starting Salary Range: $18.20 - $33.90 Annually ($54,080 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: M-F 8:30-5:00
FLSA Status: Non-Exempt
Location: Remote
Department name: SOM DOM Billing
Personnel area: School of Medicine
