Coding Quality Specialist 3

Assigns and reviews the accuracy of the diagnostic codes (ICD-10-CM) and CPT codes for Orthopedics providers’ Evaluation and Management Services (E/M), procedures and diagnostic testing in all settings for purposes of billing, research and providing information to government and regulatory agencies. Incumbent may perform only certain of the following responsibilities depending on their work assignment.

• Reviews documentation in medical record to appropriately assign ICD-10-CM, CPT-4, HCPCS and modifiers within a timely manner to capture all services rendered by providers at all locations. Encounters may be within Epic, outside electronic medical record systems, or based on paper documentation.
• Monitors, analyzes, and resolves charge review, claim edit, and coding-related denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.
• Reviews and resolves charge sessions that fail charge review edits, claim edits and follow-up work queues, identifies areas of opportunity based on findings/resolution of errors.
• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.
• Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to coding leadership and/or provider education team.
• Assists coding staff, physicians, and other health care practitioners with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to leaders.
• Ensures all coded services meet appropriate governmental regulations and guidelines, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Utilizes available resources for assignment of codes as necessary (e.g., Diagnostic Imaging system, Lab system, Emergency, Epic, and coding reference software and/or books).
• Trains and mentors Coding Quality Specialists to effectively perform their job responsibilities following current coding policies and procedures at the discretion of coding leadership
• Assists coders with medical terminology, disease processes and surgical techniques.
• Assists other coders in resolving coding issues/questions.
• Performs peer review as directed from coding leadership.
• Queries physicians to obtain clarification or missing elements in the record preventing correct coding.
• Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims.
• Completes special projects as directed by coding leadership.
• Performs charge corrections when appropriate.
• Performs other duties as assigned.

Position Compensation Range: $23.29 - $37.26 Hourly

MINIMUM REQUIREMENTS

Education: High School Diploma or GED

Experience: Five years of coding/clinical experience with training in 1-3 specialties

Licensure: Must be CPC through AAPC or CCS-P through AHIMA to qualify for all functional areas

PHYSICAL DEMANDS

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally requires traveling some distance to attend meetings, and programs.

The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Click here to read more about UVA’s commitment to non-discrimination and equal opportunity employment.