The specialist assigns and reviews the accuracy of diagnostic (ICD-10-CM) and procedural (CPT/HCPCS) codes for provider services across all settings for billing and regulatory compliance. Responsibilities include monitoring and resolving coding denials, providing feedback to providers, and assisting staff with complex coding questions.
Requirements summary
A minimum of five years of coding or clinical experience, including training in one to three specialties, is required, along with a High School Diploma or GED. Candidates must possess either a CPC certification from AAPC or a CCS-P certification from AHIMA to qualify for all functional areas.
high schoolMentoringMedical TerminologyRoot Cause AnalysisDenial ResolutionCharge CaptureHCPCS CodingCPT CodingPeer ReviewEpic SystemMedical Documentation ReviewPhysician QueryingICD-10-CM CodingCharge CorrectionCoding Guidelines AdherenceProvider FeedbackNCCI Compliance
Job description
Assigns and reviews the accuracy of the diagnostic codes (ICD-10-CM) and CPT codes for 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.
Benefits
Dental Insurance
Paid Time Off
Vision Insurance
Retirement Savings
Medical Insurance
Flexible Spending Accounts
Certification Support
Short-term Disability
Long-term Disability
Education Support
Health Saving Plans
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.
Minimum requirements
Education
High
School
Diploma or
GED
Experience: Five years of coding/clinical experience with training in 1-3 specialties
Licensure: Must have CPC certification through AAPC or CCS-P certification 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 starting base rate for this role is $24.24 hourly. Individual compensation will be determined by the selected candidate's qualifications, previous work experience, and/or education.
Benefits
Comprehensive Benefits Package: Medical, Dental, and Vision Insurance Paid Time Off, Long-term and Short-term Disability, Retirement Savings Health Saving Plans, and Flexible Spending Accounts Certification and education support Generous Paid Time Off UVA Health is a world-class Magnet Recognized academic medical center and health system with a level 1 trauma center. 2023-2024 U.S. News & World Report “Best Hospitals” guide rates UVA Health University Medical Center as “High Performing” in 5 adult specialties and 14 conditions/procedures. We are one of 70 National Cancer Institute designated cancer centers. UVA Health Children’s is named by 2023-2024 U.S. News & World Report as the best children's hospital in Virginia with 9 specialties ranked among the best in the nation. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond. The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Learn more about UVA’s commitment to non-discrimination and equal opportunity employment.
