Inside Higher Ed
Overview
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Coding Specialist III
role at
Inside Higher Ed 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
Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with 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, 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 missing information form and forward 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 advance problem solving in medical billing and coding. Professional & Personal Development
Participate in on-going 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 provide updates to providers, staff, management and administration Complete three days of training annually. Minimum Qualifications
High School Diploma/GED. Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge. CPC certification. Specialty CPC certification or second AAPC certification. Five years coding experience with demonstrated analytical skills. Experience with Medicare regulations. Understanding of third-party payer issues. 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 preferred EEO statements
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion. See https://hr.jhu.edu/benefits-worklife/ for more information. Affirmative action and equal opportunity employer information can be found at the following link: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf If you require accommodations during the pre-employment process, contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For accessibility information, visit https://accessibility.jhu.edu/.
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Join to apply for the
Coding Specialist III
role at
Inside Higher Ed 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
Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with 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, 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 missing information form and forward 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 advance problem solving in medical billing and coding. Professional & Personal Development
Participate in on-going 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 provide updates to providers, staff, management and administration Complete three days of training annually. Minimum Qualifications
High School Diploma/GED. Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge. CPC certification. Specialty CPC certification or second AAPC certification. Five years coding experience with demonstrated analytical skills. Experience with Medicare regulations. Understanding of third-party payer issues. 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 preferred EEO statements
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion. See https://hr.jhu.edu/benefits-worklife/ for more information. Affirmative action and equal opportunity employer information can be found at the following link: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf If you require accommodations during the pre-employment process, contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For accessibility information, visit https://accessibility.jhu.edu/.
#J-18808-Ljbffr