Tidelands Health
Provider Coding Specialist
role at
Tidelands Health
Employee Type: Regular
Work Shift: Day - 8 hour shift (United States of America)
Join Team Tidelands and help people live better lives through better health!
Provider Coding Specialist A Brief Overview Under the supervision of the Coding Supervisor, the Provider Coding Specialist analyzes and assigns ICD-10-CM diagnostic codes, CPT, and HCPCS codes to professional surgical patient accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Organization policy and procedure. They abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Responsibilities include abstracting required clinical information from the medical record, querying physicians to clarify documentation for accurate code assignment, organizing and prioritizing work to meet deadlines and goals, maintaining and expanding knowledge of coding and sequencing guidelines, and resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement and a clean claim rate.
What You Will Do
Analyze medical records, interpret documentation, and assign proper ICD‑10‑CM, CPT/HCPCS, and modifiers utilizing designated software, coding manuals and other reference material as required.
Enter charges for procedures that are not soft coded as instructed for certain patient types.
Consistently meet coding quality and productivity standards established by the coding department.
Work closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions, assisting with coding inquiries from billing and administrative staff to ensure accurate codes for reimbursement.
Gather and verify all information required to produce a clean claim, including special billing procedures defined by a payer or contract.
Review and resolve clearinghouse rejection errors, denials, and charge review/claim edits daily; also review accounts returned from various departments and process corrections for clean claim submission.
Collaborate with the Compliance/Quality Team on coding quality issues identified via internal or external reviews, implementing accurate coding quality recommendations.
Work with HIM operations as needed to clarify query and documentation needs; query providers to clarify incomplete or ambiguous documentation and follow up for timely resolution.
Review and code Orthopedic, OB/GYN, and other surgical specialties procedures with minimal supervision, ensuring correct coding and sequencing of diagnoses and procedures.
Provide continuous education and feedback to surgeons and clinical staff regarding ICD‑10 coding and documentation best practices for surgical procedures.
Education Qualifications
High School Diploma Required
Experience Qualifications
2+ years of abstract coding for physician services Required.
Minimum of four years of healthcare experience, with at least three years of professional coding experience in Orthopedics or OB/GYN Required.
Experience working remotely Preferred.
Skills And Abilities
Basic knowledge of ICD‑10‑CM diagnostic and CPT/HCPCS procedure codes principles and guidelines.
Basic knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and metric systems.
Basic knowledge of Standards of Ethical Coding.
Skills and ability to communicate effectively both orally and in writing.
Skills and ability to maintain working relationships with physicians and other staff.
Skills and ability to review the work of others and maintain confidentiality.
Knowledge of Microsoft Applications including Excel, Word, PowerPoint, Outlook, etc.
Strong analytical capabilities.
Strong organizational skills.
Advanced ability to function independently and be a self‑starter.
Outstanding research skills and ability to use independent judgment to solve problems.
Handle multiple priorities.
Listen and acknowledge ideas and expressions of others attentively.
Converse clearly using appropriate verbal and body language.
Collaborate with others to achieve a common goal through cooperation.
Influence others for positive and productive outcomes.
Review medical record documentation and ensure accurate diagnosis and procedure code assignment.
Expertise in assigning accurate CPT®, HCPCS Level II, and ICD‑10‑CM medical codes and modifiers based on coding and payer guidelines.
Maintain a solid understanding of anatomy, physiology, and medical terminology required to accurately code provider services and diagnoses.
Licenses and Certifications
Registered Health Information Administrator - American Health Information Management Association Required
Registered Health Information Technician - American Health Information Management Association Required
Certified Coding Specialist - American Health Information Management Association Required
Certified Coding Specialist - Physician‑based - American Health Information Management Association Required
Certified Coding Associate - American Health Information Management Association Required
Physical Demand Light Physical Demand
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.
Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.
Seniority Level
Mid-Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr
role at
Tidelands Health
Employee Type: Regular
Work Shift: Day - 8 hour shift (United States of America)
Join Team Tidelands and help people live better lives through better health!
Provider Coding Specialist A Brief Overview Under the supervision of the Coding Supervisor, the Provider Coding Specialist analyzes and assigns ICD-10-CM diagnostic codes, CPT, and HCPCS codes to professional surgical patient accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Organization policy and procedure. They abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Responsibilities include abstracting required clinical information from the medical record, querying physicians to clarify documentation for accurate code assignment, organizing and prioritizing work to meet deadlines and goals, maintaining and expanding knowledge of coding and sequencing guidelines, and resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement and a clean claim rate.
What You Will Do
Analyze medical records, interpret documentation, and assign proper ICD‑10‑CM, CPT/HCPCS, and modifiers utilizing designated software, coding manuals and other reference material as required.
Enter charges for procedures that are not soft coded as instructed for certain patient types.
Consistently meet coding quality and productivity standards established by the coding department.
Work closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions, assisting with coding inquiries from billing and administrative staff to ensure accurate codes for reimbursement.
Gather and verify all information required to produce a clean claim, including special billing procedures defined by a payer or contract.
Review and resolve clearinghouse rejection errors, denials, and charge review/claim edits daily; also review accounts returned from various departments and process corrections for clean claim submission.
Collaborate with the Compliance/Quality Team on coding quality issues identified via internal or external reviews, implementing accurate coding quality recommendations.
Work with HIM operations as needed to clarify query and documentation needs; query providers to clarify incomplete or ambiguous documentation and follow up for timely resolution.
Review and code Orthopedic, OB/GYN, and other surgical specialties procedures with minimal supervision, ensuring correct coding and sequencing of diagnoses and procedures.
Provide continuous education and feedback to surgeons and clinical staff regarding ICD‑10 coding and documentation best practices for surgical procedures.
Education Qualifications
High School Diploma Required
Experience Qualifications
2+ years of abstract coding for physician services Required.
Minimum of four years of healthcare experience, with at least three years of professional coding experience in Orthopedics or OB/GYN Required.
Experience working remotely Preferred.
Skills And Abilities
Basic knowledge of ICD‑10‑CM diagnostic and CPT/HCPCS procedure codes principles and guidelines.
Basic knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and metric systems.
Basic knowledge of Standards of Ethical Coding.
Skills and ability to communicate effectively both orally and in writing.
Skills and ability to maintain working relationships with physicians and other staff.
Skills and ability to review the work of others and maintain confidentiality.
Knowledge of Microsoft Applications including Excel, Word, PowerPoint, Outlook, etc.
Strong analytical capabilities.
Strong organizational skills.
Advanced ability to function independently and be a self‑starter.
Outstanding research skills and ability to use independent judgment to solve problems.
Handle multiple priorities.
Listen and acknowledge ideas and expressions of others attentively.
Converse clearly using appropriate verbal and body language.
Collaborate with others to achieve a common goal through cooperation.
Influence others for positive and productive outcomes.
Review medical record documentation and ensure accurate diagnosis and procedure code assignment.
Expertise in assigning accurate CPT®, HCPCS Level II, and ICD‑10‑CM medical codes and modifiers based on coding and payer guidelines.
Maintain a solid understanding of anatomy, physiology, and medical terminology required to accurately code provider services and diagnoses.
Licenses and Certifications
Registered Health Information Administrator - American Health Information Management Association Required
Registered Health Information Technician - American Health Information Management Association Required
Certified Coding Specialist - American Health Information Management Association Required
Certified Coding Specialist - Physician‑based - American Health Information Management Association Required
Certified Coding Associate - American Health Information Management Association Required
Physical Demand Light Physical Demand
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.
Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.
Seniority Level
Mid-Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr