Coding Analyst Resume Samples
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Coding Analyst Resume Samples
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BB
B Bergstrom
Brennon
Bergstrom
3302 Hobart Villages
New York
NY
+1 (555) 114 1232
3302 Hobart Villages
New York
NY
Phone
p
+1 (555) 114 1232
Experience
Experience
New York, NY
Coding Analyst
New York, NY
Bradtke and Sons
New York, NY
Coding Analyst
- Following Compliance Department protocols and annual Work Plan, reviews medical record documentation, coding, and billing for Lancaster General Health
- Track and trend contract performance through key performance indicators
- Charge Review: Resolve Claims Manager and Epic Edits to ensure correct coding of services provided. This includes review of documentation for correct coding and E/M leveling, diagnosis coding, bundling issues, modifier usage, etc
- Knowledge:Maintain knowledge of medical coding and documentation standards, including CMS documentation and billing guidelines, CPT-4, ICD-9-CM, ICD-10-CM and HCPCS
- Performs ongoing critical assessment of coding CPT and diagnosis assignment on all types of specialties to include assessment for accuracy, and compliance with Coding Guidelines. Abstract pertinent information from patient records and assigns ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and/or HCPCS codes, Review claims, ensure accurate charge capture and review medical necessity for all. Follows guidelines for coding and documentation to ensure physicians and hospital compliance. Remains current with coding information to ensure accuracy of codes assigned based on documentation. Guides, supports, and sponsors concurrent clinical coding. Provides clinical interpretation of physician documentation. Acts as a liaison between the clinical and coding functions
- Problem Solving/Process Improvement:Evaluation of current processes for improvement; including charge review edits, policies and procedures, and denial trends. Identification and recommendation of solutions
- Work through Billing Specialist Work File ensure completeness for 99211 claims, review for missing modifiers on claims, review /force out 96521 and 96416 claims, ensure complete and accurate ordering/render MD info on claims, review/correct duplicate claims and bundled charges
Houston, TX
Medical Coding Analyst
Houston, TX
Johnston-Schuppe
Houston, TX
Medical Coding Analyst
- Responsible for providing coding support to the DataRAP® Clinical Coding Nurses and to the providers participating in the DataRAP® process
- Audit codes and professional fee services performed by providers from medical records according to ICD-10, CPT, ASA, and CMS guidelines
- Associates attestation sheets received into the DataRAP® database to provide tracking for all markets
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note
- Create documents pertaining to clinical data to support product development, license application, and post-marketing maintenance, on behalf of and in conjunction with corresponding project teams. Some examples of such documents include briefing documents to support meetings with regulatory agencies, clinical documents for marketing authorization (new drug) applications (Clinical Overviews and ICH module 2.7 clinical summaries), and responses to clinical and safety questions from regulatory authorities
- Collaborate with quality lines and relevant project team subject matter experts, ensuring the accuracy and quality of information presented in assigned documents
- Ensure assigned documents are produced in accordance with relevant internal SOPs and external regulatory guidance, alerting project teams and line management in a timely manner of any definite or potential deviations
present
Chicago, IL
Quality / Education Coding Analyst
Chicago, IL
Cartwright Group
present
Chicago, IL
Quality / Education Coding Analyst
present
- Provides manager with quality and quantity performance data for use in performance reviews. Provides input into staff evaluations
- Assists with the development of actions plans and implements with the oversight of the manager
- Assists coding staff in resolving ITS issues impacting work efficiently; facilitates ticket submission,
- Assists manager in monitoring and reporting coder productivity
- Quantity of reviews performed meet established standards
- Assists in the development and updating of procedures to maintain standards for correct coding
- Provides input in the development, refinement and implementation of methods and procedures used to complete review functions
Education
Education
Bachelor’s Degree in Business
Bachelor’s Degree in Business
University of Central Florida
Bachelor’s Degree in Business
Skills
Skills
- Ability to analyze, research, and find viable solutions to problems and implement solutions in a timely manner
- Ability to multi-task and detailed-oriented
- Knowledge of Microsoft Word & Excel
- The organization skills to perform consecutive detail-oriented tasks accurately
- Excellent computer kkills, i.e Excel, Word, Outlook
- Ability to multi-task
- Detail-oriented
- Excellent customer service skills
- Excellent verbal and written communication skills
- Demonstrated ability to work independently
15 Coding Analyst resume templates
Read our complete resume writing guides
1
Coding Analyst Resume Examples & Samples
- 3+ years of healthcare and medical claims processing experience within a provider/facility’s office or Payer
- CPC or equivalent credentialing
- Exceptional written communication skills
- Diligent research and organizational skills
- Knowledge of Microsoft Word & Excel
2
Senior Coding Analyst Resume Examples & Samples
- 8+ years of Healthcare and Medical Claims processing experience within a Provider / Facility's office or Payer
- CPC or CCS-P certification
- Appeals experience
- Proficiency in Medical Coding
- Developed understanding of relevant technical aspects of Claims Edit software and solutions
- Computer proficiency and technical aptitude with the ability to utilize CMS, MS Word, Excel, Power Point, Access
- Exceptional project management skills
3
Junior Coding Analyst Resume Examples & Samples
- 3+ years of healthcare and medical claims processing experience within a provider/facility's office or Payer
- CPC or equivalent credentialing, maintained in good status
- Has a basic knowledge of medical coding and use of various research manuals and guidelines used to render decisions
- Computer proficiency and technical aptitude with the ability to utilize CMS, MS Word, Excel, Power Point, and Access
- Has basic understanding of relevant technical aspects of Claims Edit software and solutions
- Exceptional professionally written communication skills
- Knowledge of Microsoft Word & Excel a must
4
Coding Analyst Resume Examples & Samples
- 5+ years healthcare and medical claims processing experience within a provider/facility's office or Payer
- Ability to multi-task and detailed-oriented
- Knowledge of Microsoft Word and Excel
5
Asset Coding Analyst Resume Examples & Samples
- Set up new Security records on NT systems
- Work in line with Audit, Risk and Compliance parameters as outlined for each Department
- Business or financial services qualification
- Excellent PC skills especially proven MS Excel ability
- Awareness of securities data, corporate actions, Funds, Stock exchange data etc. an advantage
- Industry Knowledge - Knowledge of financial instruments, valuations business & regulations an advantage
- Working knowledge of Bloomberg, Reuters, FT Interactive Data and Telekurs an advantage
- Excellent administration and organisational skills
- Excellent multi-tasking ability in order to adhere to strict daily deadlines
- Ability to display initiative, confidence and professionalism in all dealings with cross functional business units
6
Senior Health Care Coding Analyst Resume Examples & Samples
- Review applicable Federal and State Medicaid policies and regulations governing healthcare reimbursement
- Perform additional research as may be necessary to determine the standards applicable to billing compliance with Medicaid or other government program regulations
- Apply such policies and standards to specific reviews and audits
- Perform data analytics to identify fraud, waste or abuse of Medicaid or other health care system funds
- Review and analyze medical, financial or other records for inpatient, outpatient and/or professional services to identify coding errors, inconsistencies, anomalies, abnormal billing patterns and other indicators of suspected fraud, waste or abuse (e.g. services not rendered, up-coding, un-bundling, etc.)
- Prepare written reports and/or summaries of the results of reviews and audits
- Maintain security and confidentiality of all protected health information handled during reviews
- Handle phone calls and e-mails from providers to answer any questions
7
Office Based, Medical Coding Analyst Resume Examples & Samples
- Processes attestation sheets and progress notes out of the RightFax work queue according to DataRAP® department guidelines
- Analyzes progress notes and documentation sent by providers for validation following CMS guidelines and ICD-9 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP® database
- Performs the minimum number of validations consistent with established departmental goals
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard as identified by “no plan”
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note
- Ensures accuracy of entry by comparing to outcome of diagnoses on eAttestation post validation entry
- Associates attestation sheets received into the DataRAP® database to provide tracking for all market
- Identifies and reports quality concerns and errors to DataRAP® Clinical Process Quality Analyst for review and education
- Responsible for providing coding support to the DataRAP® Clinical Coding Nurses and to the providers participating in the DataRAP® process
- CPC certification or proof that certification has been obtained within nine months of hire date from the American Academy of Professional Coders
- Knowledge of ICD-9 CM guidelines and coding
- Must have the ability to perform in a deadline driven environment
- Must be able to maintain professionalism and a positive service attitude at all times
- Ability to analyze facts and exercise sound judgment when arriving at conclusions
- Ability to effectively report deficiencies with a recommended solution in oral and/or written form
- Some college experience
- Two to four years of medical coding experience with strong attention to detail and a high level of accuracy in a clinical or managed care setting
- Experience with proprietary medical coding systems
8
Medical Coding Analyst Resume Examples & Samples
- Processes attestation sheets and progress notes out of the RightFax work queue according to DataRAP® department guidelines
- Analyzes progress notes and documentation sent by providers for validation following CMS guidelines and ICD-10 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP® database
- Performs the minimum number of validations consistent with established departmental goals
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard as identified by no plan
- Identifies and reports quality concerns and errors to DataRAP® Clinical Process Quality Analyst for review and education
- Responsible for providing coding support to the DataRAP® Clinical Coding Nurses and to the providers participating in the DataRAP® process
- CPC certification or proof that certification has been obtained within 9 months of hire date from the American Academy of Professional Coders
- Knowledge of ICD-10 CM guidelines and coding
- Some college experience
9
Coding Analyst Resume Examples & Samples
- Charge Review: Resolve Claims Manager and Epic Edits to ensure correct coding of services provided. This includes review of documentation for correct coding and E/M leveling, diagnosis coding, bundling issues, modifier usage, etc
- Follow-Up:Review and correct charge sessions in the Follow-Up WQs if coding changes are appropriate for resolution of claim denials. This requires knowledge of correct coding and payer rules, research of billing requirements and documentation review
- Problem Solving/Process Improvement:Evaluation of current processes for improvement; including charge review edits, policies and procedures, and denial trends. Identification and recommendation of solutions
- Provider/Staff Feedback:Maintain excellent customer service and professionalism in written and verbal communications when interacting in the workplace
- Knowledge:Maintain knowledge of medical coding and documentation standards, including CMS documentation and billing guidelines, CPT-4, ICD-9-CM, ICD-10-CM and HCPCS
10
Healthcare Coding Analyst Resume Examples & Samples
- Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies
- Extracts information from resources and translates information needed to form appropriate logic for rules. Also responsible for HMEDICAR table build, documentation and Quality Assurance review. Completes CTE table builds, review and complete integrity checks for multiple software products as these edits are used, or modified, for varying levels of ICD-9-CM (ICD-10) review and Medical Necessity checking
- Completes reviews of medical policies and publications and its integration into the required database on a timely basis. Identifies patterns of improper coding or errors in policies and publications and is able to resolve and recommend alternate codes, or code representation is appropriate table(s) (Diagnosis, CPT/HCPCS, CCI_Edits)
- Prepares documentation and reviews as needed with the Director. Reviews forwarded Technical Support information/documentation for completeness and accuracy. Composes responses and discusses with clients if necessary
- Maintains all medical rules editorials in the appropriate MS Access database utilizing programmatic tools Ability to research and analyze data
- Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stays abreast of current coding issues
- Associate’s or Bachelor’s degree in the Life Sciences or Accredited Record Technician’s certification (ART) or Certified Procedural Coder certificate (CPC)
- Experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-9 and/or ICD-10) Codes required. Ability to understand and retain coding information, and transfer that information into completed product data
- Ability to maintain effective working relationships is essential
- Knowledge of anatomy and physiology
- Knowledge of Medicare reimbursement guidelines
- Standard English grammar/usage and proper telephone etiquette
- Must be able to write in a clear and understandable manner
- Prior experience in developing medical policy edits desired
- Must be able to exercise independent judgment
- Previous Healthcare experience desired
- Must have high standards with extreme attention detail
- Previous experience as an outpatient Medical Coder is a plus
11
Medical Coding Analyst, CPC Resume Examples & Samples
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note
- Ensures accuracy of entry by comparing to outcome of diagnoses on eAttestation post validation entry
- Associates attestation sheets received into the DataRAP® database to provide tracking for all markets
- Knowledge of ICD-9/ICD-10 CM guidelines and coding
- Must have the ability to perform in a deadline driven environment
- Ability to analyze facts and exercise sound judgment when arriving at conclusions
- Ability to effectively report deficiencies with a recommended solution in oral and/or written form
- Two to four years of medical coding experience with strong attention to detail and a high level of accuracy in a clinical or managed care setting
- Experience with proprietary medical coding systems
12
Coding Analyst, / Auditor Resume Examples & Samples
- Ability to work as a team member
- Must have prior accreditation/credentialing (CPC, CPC-A, CCS-P, etc.)
- Must have at least one year of medical billing experience
- Average knowledge of Word and Excel
13
Senior Coding Analyst Resume Examples & Samples
- Implements, maintains, and creates ad hoc assignments in regards to Conifer systems, processes, and policies designed to ensure coding compliance
- Independently investigates breakdown in processes and coordinates resolution for system reporting issues
- Conducts independent analysis of data and trends; advises Coding Compliance Managers/Directors on issues concerning coding compliance risk areas and training needs
- Works collaboratively with Coding Compliance Managers and Directors, other corporate departments and Clients on monitoring and reporting implementation as well as establishing analysts processes and procedures
- Recommends new methods and processes that improve safeguarding Conifer and Clients in coding functions and strategic planning to mitigate risks associated with coding practices
- Works with other areas of the organization (including Dell and Conifer Revenue Cycle Services), at the corporate, regional and facility/provider levels in the areas of data mining and business intelligence on issues related to coded data
- Prepares and maintains templates for Conifer coding compliance audits
- Keeps abreast on regulatory changes in coding requirements and analyze for potential safeguarding opportunities
- Work directly with other Compliance team members to complete additional tasks/projects that are beneficial to the department or organization
- Serves as back-up coding compliance auditor
- Ability to work independently in a fast paced environment; strong organizational skills and experience is project management highly preferred
- Must successfully pass pre-hire coding assessment
- Knowledge of medical terminology, ICD-9/10 and CPT-4 coding guidelines and methodologies
- Intermediate knowledge of disease pathophysiology and drug utilization
- Intermediate knowledge of MS-DRG classification and reimbursement structures
- Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures
- Must be detail oriented and have the ability to work independently
- Must display excellent interpersonal skills
- Ability to demonstrate initiative and discipline in time management and assignment completion
- Ability to work in a virtual setting under minimal supervision
- Associates Degree in Business, Information Systems, Health Care Administration or related field or equivalent years of related Analyst experience is required
- Demonstrates one to three years of experience in a healthcare organization applying ICD-9/10 and CPT coding conventions and guidelines, preferably in a hospital facility
- AHIMA certification RHIT, CCS, or CCA required. Will consider a candidate who is CCA eligible within one year of hire
14
Coding Analyst Emergency Department Coder Resume Examples & Samples
- Position may work from home following necessary training and must be available for onsite training and team meetings. (This position is not able to accomodate working from another state remotely)
- To be successful, the Coding Analyst must be able to
- Code and abstract clinical and demographic data for inpatient, outpatient, or clinic encounters using standardized coding regulations, abstracting rules, and Fairview guidelines
- Identify and resolve clinical documentation and charge capture discrepancies to improve quality of the clinical documentation, severity and reimbursement levels assigned, integrity of charges data reported
- Educate multidisciplinary team members, including physicians, as it pertains to frequently changing mandated rules, regulations and guidelines to ensure a complaint claim
- Meet departmental quality and productivity standards
- Certificate program in coding or associate degree in HIM or equivalent healthcare coding experience
- At least one year of surgery coding experience or ED Coding required
- Inpatient Coding: Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS)
- Outpatient or Professional Fee Coding: Registered Health Information Technician (RHIT) , Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Coding Specialist – Professional (CCS-P) or Certified Professional Coder – Hospital (CPC-H)
15
Medical Coding Analyst Resume Examples & Samples
- Create documents pertaining to clinical data to support product development, license application, and post-marketing maintenance, on behalf of and in conjunction with corresponding project teams. Some examples of such documents include briefing documents to support meetings with regulatory agencies, clinical documents for marketing authorization (new drug) applications (Clinical Overviews and ICH module 2.7 clinical summaries), and responses to clinical and safety questions from regulatory authorities
- Provide project teams with expertise on regulatory requirements and corporate policies governing documents for regulatory submission. Provide project teams with expertise and strategic guidance on analysis and presentation of clinical and safety data and on benefit-risk assessment in documents
- Assess document requirements, gauge document complexity, and identify information gaps or other potential issues. In collaboration with the relevant project team, the author proposes or contributes to strategies to resolve any identified issues
- Lead a team of internal or external (contractor) authors if multiple or complex documents are required for a particular project
- Support clinical teams by providing analyses of clinical data, reviews of the medical literature, and similar related activities
- Communicate clinical’s position on resource and timeline needs for assigned documents to project team members, negotiating as needed with the team on these matters and keeping line management informed
- Ensure assigned documents are produced in accordance with relevant internal SOPs and external regulatory guidance, alerting project teams and line management in a timely manner of any definite or potential deviations
- Drive the document strategies and messages in a collaborative way with relevant project team subject matter experts. Ensure clear, factual, effective, and appropriately concise presentation of analyses and associated discussions in assigned documents
- Deliver assigned documents on or before deadline, alerting project teams and line management in a timely manner of any anticipated delays, information gaps or potential shortcomings in quality
- If leading a team of other authors (internal or external), be accountable for timely delivery of high-quality, fit-for-purpose documents to the project team
- Produce documents in conjunction with external vendors. Review documents produced by vendors and help evaluate vendor performance
- Collaborate with quality lines and relevant project team subject matter experts, ensuring the accuracy and quality of information presented in assigned documents
- Develop and sustain constructive relationships within other client lines including country organizations
- If assigned by manager, serve as the clinical ‘point of contact’ for all document issues for a given product or set of products
- Identify potential areas for process improvements and possible solutions, and communicate these to line management or appropriate functional line.Search Jobs US
16
Clinical Research Billing & Coding Analyst Resume Examples & Samples
- To provide a source for appropriate billing for research subjects, the CRBCA must ensure that the correct billing codes (CPT and CDM) are assigned to each item/service on each billing calendar
- 1-3 years of progressively responsible experience in medical billing and/or medical record coding
- Knowledge of common billing practices
17
Lead Benefit Coding Analyst Resume Examples & Samples
- New Benefit Coding: Translates or reviews the work of less senior Benefit Coding Analysts for new benefit policies to ensure that associated benefits are designed and configured appropriately in KP systems to ensure accurate assignment to industry standard codes to ensure appropriate billing and claims adjudication and receipt of accurate member cost-share at point of service. Partners with and may manage the relationship with Benefits Systems Management (BSM) to resolve testing gaps during implementation
- Charge Capture: Partners with Revenue Cycle to ensure new benefits that require capture of appropriate charges are built into health plan systems. Resolves escalated issues and participates in Revenue Cycle initiatives
- Code Updates: May lead or oversee the work of less senior Benefit Coding Analysts to ensure quarterly and annual CPT, HCPC, and ICD-9/10 codes are updated. Responds in a timely manner to production issues related to coding issues
- Coding Production: Oversees and leads the work of less senior Benefit Coding Analysts to resolve coding related production issues
- Benefit Codification: May lead or oversee the work of less senior Benefit Coding Analysts responsible for continually updating and maintaining the Benefit Codification Tool (BCT), ensuring that KP's coding source of record reflects key changes made and is up to date
- Strategic Projects & Governance: Participates in and may lead project teams to assess impacts of external changes (health care reform, ICD-10) as well as internal initiatives requiring benefit policy and coding expertise. Single point of accountability for all health plan. Approves KP code assignment and approves solutions for benefits. Provides direction/decisions on escalated issues
- Workflow Management: Responsible for day to day leadership of managing the coding pipeline to ensure appropriate responses to shifts in priorities. Evaluates incoming requests and notifications of issues to ensure effective and timely resolutions
- Minimum seven (7) years of experience in revenue cycle, pricing, or charge description/fee schedule development or claims billing experience
18
Certified Professional Clinical Coding Analyst Resume Examples & Samples
- Provide professional and analytical support with policy interpretation to medical services programs including implementation, operations, and contract compliance
- Document research, coverage determinations, and findings and present the impacts to benefit offerings
- Research and identify best practices and evidence based research studies in support of coverage determinations
- Consult with industry resources, regulatory authorities, and health plan administrators to help ensure the development and maintenance of medical services guidelines
- Operate independently and take action rapidly in a complex organizational environment with daily customer interaction
- Certified Professional Coder certification
- Minimum of 3 years of health care or medical industry experience
- Minimum of 2 years proficiency in using PC software, including Microsoft Word and Excel
- Associates degree or higher in health care or a medical field
- Prior health insurance, Medicaid, and/or claims processing, including ICD, NCCI and HCPCS experience
- Significant experience using spreadsheet and word processing functionality
- Flexibility and ability to manage a variety of assignments in various stages at the same time
19
Medical Coding Analyst Resume Examples & Samples
- Trains and monitors coding/HCC and billing services to ensure compliance with all government and contractual obligations. Participates in internal and external audits
- Prepares and maintains a variety of statistical reports and records while ensuring strict confidentiality of financial and medical records
- Resolves daily coding scrubber errors to insure accurate coding structure for correct billing
- Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required for the resolution of coding denials
- Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews;; prepares periodic reports for the HCC findings, trends and clinical staff identifying corrective measures necessary to resolve denial problems
- Develops and conducts thorough formal and informal provider education sessions and Participates in organizational meetings as required
- Completes appropriate HCC paper work/documentation/system entry related to the claim/encounter information
- Required – One (1) year of related experience
- Preferred – Two (2) years of related experience
- Ability to communicate effectively; Ability to work independently; Ability to analyze and interpret data; Advance computer skills. Knowledgeable in Microsoft word, Excel and PowerPoint
20
Risk Adjustment Coding Analyst Resume Examples & Samples
- Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records
- Review and identify trends in coding discrepancies and notify applicable department for potential training and education
- Determine coding issues and discrepancies and make updates as necessary
- Identify issues
- Determine impact to risk adjustment models and reports results for various products and services
- Coordinate delete files with leadership from Medicaid, Medicare, and Marketplace and Encounters department
21
Medical Coding Analyst Resume Examples & Samples
- Analyzes progress notes and documentation sent by providers for validation following CMS guidelines and ICD-9/ICD-10 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP® database
- Provides clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard as identified by “no plan”
- CPC certification or proof that certification has been obtained within nine months of hire date from the American Academy of Professional Coders
- Knowledge of ICD-9 / ICD-10 CM guidelines and coding
- Ability and willingness to travel (locally and non-locally) as determined by business need
22
Coding Analyst Resume Examples & Samples
- Responsible for product Interchange analysis and updates
- Create and maintain MINO numbers and all data elements associated with item data
- Work with large files for coding and cross referencing acquired companies’ product data
- Map supplier product files to eCos for search enhancements
- Process Coding requests through COS and eCos
- Assist branches with codes and questions
- Assign manufacturer numbers
- Supplier location creation and updates
- Track daily, weekly and monthly activity statistics
- Product knowledge required (Traditional and Industrial)
- Must be familiar with Motion Industries Product Group Code Classification System
- Excellent proficiency in Microsoft Office (Outlook, Access, Word, PowerPoint – high proficiency in Excel required)
- Great analytical skills; must be able to analyze and work with large amounts of data
- Must be able to communicate well both written and verbally
- Ability to listen to branch problems and troubleshoot for solutions
- Effective proofreading skills; experienced in utilizing web and printed product catalogs
- Ability to multi-task and meet deadlines on a consistent basis
- Service oriented and must be a solid team player
23
M HIS Coding Analyst Resume Examples & Samples
- Analyze change rates/patterns (engine vs. coder)
- Conduct regularly scheduled coding calls with clients to review top changes and provide consultation
- Research and document clients’ change requests
- QA changes made by engineers (as needed)
- Run database queries and reports
- Assist Client Engagement Executives, Project Managers, and Support as needed to resolve client issues and optimize client satisfaction
- Reply promptly to client e-mails with questions about the NLP engine and/or coding issues
- Other duties are assigned as new opportunities present themselves
- High School Diploma/GED or higher from an accredited institution
- Minimum of seven (7) years of Clinical Analyst experience
- Minimum of one (1) of the following, current certification: CPC, CCS, RHIA or RHIT
- Minimum of one (1) year of Outpatient Facility Coding experience
- Minimum of one (1) year of EM Coding experience
- Advanced Coding Skills (at least 7 years)
- Multi-specialty EM
- Facility Outpatient EM
- Radiology Coding
- Pathology Coding
- Cardiology/VIR
- Surgical Coding
24
Coding Analyst Resume Examples & Samples
- Perform chart audits for priority ED and/or Hospitalist clients to identify potential revenue opportunities due to incomplete or missing documentation
- Gather chart examples and general documentation issues for the purpose of educational feedback to be provided by Director(s) of Practice Improvement
- Perform ad-hoc chart audits when requested for individual providers or contracts
- Use EmBillz/I-Med reports to identify areas for focused chart audits, i.e. Downcodes, Nonbillables, procedural coding, etc
- Maintain up-to-date knowledge of coding and regulatory policies, procedures, and guidelines
- Participate in Practice Improvement team discussions regarding new startups and/or physicians, revenue potential issues, EMR conversions, and documentation guidelines, etc
- Compile all charts and chart feedback into user-friendly packets for distribution
- Track and trend contract performance through key performance indicators
- Provide internal feedback to Practice Improvement team regarding documentation deficiencies identified
- Identify physicians that require 1-1 contact with the Director of Practice Improvement
- Adhere to all company policies and procedures
- Be flexible with shifting daily priorities
- Meet deadlines, working within tight time constraints
- Handle a large volume of work
- Communicate a willingness to help others succeed
- Demonstrate and promote a spirit of teamwork and cooperation
- Convey and inspire a sense of competence and commitment
- Use initiative to learn new skills, enhance personal knowledge and improve communications
- One to two years coding related experience and/or training; or equivalent combination of education and experience preferred
- Understanding of hospital ED operations and medical records operations is preferred
- Ability to analyze financial reports
- Familiarity with medical terminology
- Acute attention to detail preferred
- Excellent computer kkills, i.e Excel, Word, Outlook
25
Benefits Coding Analyst Resume Examples & Samples
- New Benefit Coding: Translates less complex new benefit policies to ensure that associated benefits are designed and configured appropriately in KP systems to ensure accurate assignment to industry standard codes to ensure appropriate billing and claims adjudication and receipt of accurate member cost-share at point of service
- Partners with Benefits Systems Management (BSM) to resolve testing gaps during implementation
- Code Updates: Ensure quarterly and annual CPT, HCPC, and ICD-9 codes are updated
- Responds in a timely manner to production issues related to coding issues
- Coding Production: Resolves coding related production issues
- Benefit Codification: Responsible for continually updating and maintaining the Benefit Codification Tool (BCT), ensuring that KP's coding source of record reflects key changes made and is up to date
- Minimum two (2) years of experience in revenue cycle, pricing, or charge description/fee schedule development or claims billing experience
- Experience in both established benefit coding environments as well as experience in determination of coding requirements for new benefits preferred
- Experience resolving billing and claims issues related to benefit to code assignment preferred
26
Coding Analyst Resume Examples & Samples
- Serves as a role model for compliant and ethical behavior consistent with the mission, vision, and values of Lancaster General Health
- Following Compliance Department protocols and annual Work Plan, reviews medical record documentation, coding, and billing for Lancaster General Health
- Independently interacts with “customers” and leads them through the review process. When deficiencies are identified, works with staff, management, and/or physicians to obtain corrective action plans. Makes recommendations and performs follow-up when appropriate
- Prepares written reports of findings according to Compliance Department protocols
- Prepares and presents educational information as required
- Assists with external reviews as needed
- Monitors trade publications and regulatory updates for potential areas of risk to LG. Requests reports, analyzes data, and performs risk assessments
- Maintains knowledge of code changes
- Manages projects as assigned
- Raises issues of concern to the Compliance Officer, or other appropriate resource in order to validate and remediate problems
- Obtains working knowledge of the in-house coding software, documentation imaging system, billing system(s), various reporting systems (e.g., Midas, SMS, RAS, Intellect), and the EPIC inpatient and outpatient electronic health record
- Pursues problems or potential problems until full resolution, requesting assistance and direction from the Compliance Officer when needed
- Maintains knowledge of applicable federal, state and other regulations
- Performs regulatory research as needed
- High school Diploma or Equivalent
- Coding certification (e.g., RHIA, RHIT, CCS, CCS-P, CPC, CPC-H)
- At least three (3) years of coding experience. In lieu of coding experience, must have proven analytical skills and writing ability
- Knowledge of rules and regulations pertaining to federally funded programs (e.g., Medicare, Medicaid)
- Ability to affect change while maintaining positive relationships
- Highly developed analytical and organizational skills; excellent written and verbal communication skills and the ability to articulate difficult concepts in an understandable manner
- Ability to prioritize work load and to self manage
- Microsoft Word, Excel, PowerPoint and Outlook
- Ability to navigate through difficult situations
- Clinical background and knowledge acquired by serving in a CMA, LPN or RN role
- CCA certification for those without practical experience
- Associates degree in medical coding
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Inpatient Coding Analyst, RIC Medical Records Resume Examples & Samples
- Perform other related duties as assigned or requested
- 1-2 Years of ICD-10-CM and ICD-10-PCS coding experience and clinical knowledge
- Knowledge of regulatory, billing, and other coding guidelines
- RHIA, RHIT, CCS, or CCS-P certification required, and maintains continuing education requirements
- Advanced computer skills, PC-experience with Windows based applications. Experience with hospital information systems and encoder experience preferred
- Interpersonal skills necessary to effectively communicate with other departments, physicians, and key customers
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Coding Analyst Resume Examples & Samples
- Requires a high school diploma; 1 year of experience; or any combination of education and experience, which would provide an equivalent background
- Certified Medical Code (CPC or CCS-P) required
- Knowledge of medical terminology and anatomy required
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Senior Medical Coding Analyst Resume Examples & Samples
- Demonstrated aptitude to understand and following nationally accepted coding guidelines
- Demonstrated knowledge of medical billing and collection activity
- Demonstrated understanding of GE/IDX automated billing system and third party reimbursement of professional services
- Strong interpersonal and communication skills
- Demonstrated proficiency in Microsoft Office
- Demonstrated knowledge of anatomy/physiology and medical terminology
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Medical Coding Analyst Resume Examples & Samples
- Perform other job-related duties within the job scope as assigned
- Summary of job responsibilities
- Associate's degree (A.A.) or equivalent from a two-year college or technical school; Coding Certification (CPC or AHIMA)
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding, billing procedures and documentation
- Ability to work independently to analyze and solve problems
- Ability to communicate effectively both verbally and in written form
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FTP Coding Analyst Resume Examples & Samples
- Troubleshoot FTP job problems
- Consult with colleagues and customers about FTP function and configuration
- Design and create directory structures on internal FTP servers
- Ensure compliance to relevant security policies and directives
- Demonstrates growing knowledge level, usually in a specific area within Information Systems and Technology
- Can execute assignments of modest complexity
- May show modest technical leadership in areas of specialization
- Improvement opportunities
- Recommends alternate solutions to moderately complex problems
- Begins to incorporate client perspectives as context for developing choices
- Bachelor’s Degree with 5+ years OR Master’s Degree with 3 years OR 6 – 8 years applicable business experience
- Demonstrated proficiency with Windows Command scripting and Unix Shell scripting
- Working knowledge of FTP and SFTP command syntax
- Experience with PGP encryption software
- Experience with PERL programming language
- Familiarity with Windows and Unix file systems
- Skills needed to troubleshoot and resolve file transfer issues
- Availability to provide 24/7on call
- Assistance for file transfer batch processes
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Associate Benefits Coding Analyst Resume Examples & Samples
- Work with customers, application developers, architects, project management and team members to understand business requirements that drive the analysis and design of quality business solutions. Communicate effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality
- Work independently or a team member, to develop benefits and medical policy coding applications/solutions and perform project activity. Provide required business and/or subject matter expertise for both project and production related activities. May also participate as a subject matter expert in strategy development for new strategic programs
- Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims
- Provide assistance on development of project deliverables – e.g. vision documents, business requirements, use cases, supplemental specifications, user design, testing plan, testing schedule, testing scenarios, testing outcomes, approvals, and training materials
- Manage job tasks and project requirements so that work is completed on time, in scope, within budget, and with minimal defects
- Perform root cause analysis and coding implementation to include
- Data clean-up
- Business procedures implementation (suspense correction)
- Business/Technical sign-off on CRs and projects
- Follow coding structured protocols and maintain coding documentation. Perform system testing for coding group and production applications. Assist in development of testing plan, scenarios, documentation and defect management to ensure minimal production defects are realized. Complete analysis of the results tying back to customer impacts. Interface closely with the business and technical staff during all phases of a project, including unit and system testing, integration and UAT testing culminating with implementation checkout and post implementation support
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Coding Analyst Resume Examples & Samples
- Reviews, verifies and records accurate ICD and CPT codes in accordance with coding and reimbursement guidelines
- Works with Manager of Quality Assurance (QA Manager) and charge entry staff to ensure correct charge and/or quantity amounts
- Run Admix Report every daily (am) and send to sites
- Run Missing Ticket Report weekly and at Month End- send to QA Manager
- Force Extract Gyn Onc claims following QA Manager approval
- Code Hospital tickets and ensure all required ticket information is complete and accurate
- Work through Billing Specialist Work File * ensure completeness for 99211 claims, review for missing modifiers on claims, review /force out 96521 and 96416 claims, ensure complete and accurate ordering/render MD info on claims, review/correct duplicate claims and bundled charges
- Work through CBO Review work file * ensure complete and accurate information for assigned visit, referring MD, NDC#s for any NOC drug, matching ordering MD vs MD1
- Communicate with site clinical staff as needed to complete any of the tasks above
- Other duties as assigned by Business Office Director
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Lead Medical Coding Analyst Resume Examples & Samples
- Responsible for leading and supporting the department teammates, supervisor and manager to ensure that appropriate Coding for reimbursement and HCC’s conforms to applicable guidelines and regulations
- Responsible for equitable distribution of work and insuring coding/HCC reviews, denials, education, IDX edits, communication with clinics and assigned projects are processed in a timely manner
- Schedules staff in accordance with workflow and workload and trouble shoots problem areas
- Preforms ongoing quality and productivity monitoring of teammates in the Coding department and provides monthly feedback in the form of reports to the supervisor/manager. While ensuring strict confidentiality of financial and medical records
- Coordinates and performs training and orientation of new teammates
- Coordinates new provider training, educational in-services and serves as a first line resource for coding questions
- Provides input for performance evaluations and hiring
- Audits and monitors coding and billing services to ensure compliance with all government and contractual obligations. Participates in internal and external audits
- Prepares and maintains a variety of statistical reports and records Resolves daily coding scrubber errors to insure accurate coding structure for correct billing. Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required for the resolution of coding denials
- Develops preventive measures in response to patterns identified through analysis of claims denial data; prepares periodic reports for clinical staff identifying corrective measures necessary to resolve denial problems
- Participates in organizational meetings as required
- Required: Two (2) years’ experience as a coder
- Must have one of the following coding certifications at the time of hire: CCS,CCA,CCS-P, CPC, CPC-H
- Working knowledge of 10-key calculator
- Working knowledge of contracted insurance plans
- Good telephone skills
- Ability to maintain courteous and friendly demeanor when dealing with the public and co-workers
- Task-oriented
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Coding Analyst, Senior Resume Examples & Samples
- 4 years of Provider billing experience in a lead, supervisory or management role or
- 3 years in a payor environment working directly with payment quality and accuracy in a claims processing, provider contracting or audit capacity or
- 3 years in a compliance or audit function within a healthcare system
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Law Coding Analyst Resume Examples & Samples
- Analyze regulatory and business requirements
- Code and test processing parameters for fees, interest rate calculations, insurance premiums and refunding methods
- Provide support to branches, headquarters and compliance regulators by researching items
- Setup and realign branch network hierarchy for tracking and reporting
- Assist in branch openings by ensuring appropriate law is available for loan originations and servicing
- Assist in branch closings by ensuring accounts are moved to designated branches
- Teamplayer
- Strong time management
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Prepay Coding Analyst Resume Examples & Samples
- Independently perform analysis of high risk and/or high dollar claims on a pre-payment basis utilizing coding and claims processing backgrounds to ensure claims are neither over nor underpaid
- Perform medical chart audits to assure that codes billed are appropriate and supported by documentation in the patient’s record with the appropriate CPT, HCPC or ICD-10 code
- Leverage coding background to assess high risk claims for inappropriate application of associated Florida Blue policies and industry standard billing and care practices that may impact claims payment (e.g. MCG, LCD, Authorizations, Covered Benefits and Appropriateness of Service Setting). Specifically
- Strong analytics experience
- Consulting experience
- Ability to read and interpret medical records
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Quality / Education Coding Analyst Resume Examples & Samples
- Assesses accuracy of MSDRG, APRDRG and APC assignment
- Confirms appropriate identification, coding and sequencing of pertinent secondary diagnoses and procedures severity of illness, etc
- Confirms coding of all diagnoses required to validate medical necessity
- Validates the use or nonuse of the query tool
- Responsible for entry into database for tracking and trending
- Reviews audit with coder and coordinates with the CBO to re-bill of accounts as needed
- Monitors for coder error trends in reviews and advises appropriate manger of identified trends/patterns
- Identifies issues that relate to the clinical department and/or physician documentation and submits to denials management
- Reviews records identified for HARMS; reconciles discrepencies with appropriate clinical department, Risk Management, Quality etc
- Provide coding review summary reports to management as required
- Accuracy of reviews 95% standard (As validated by Senior Analyst audits)
- Quantity of reviews performed meet established standards
- Provides feedback to employee on identified issues found during record review with supportive documentation as needed
- Responds timely to coder requests for assistance
- Provides manager with quality and quantity performance data for use in performance reviews. Provides input into staff evaluations
- Monitors for trends during review process and advises appropriate manager of identified trends/patterns reflecting need for individual action plan(s) or section education
- Assists with the development of actions plans and implements with the oversight of the manager
- Assists in the development and updating of procedures to maintain standards for correct coding
- Participates in the coder interviews and administers coding skill test
- Collaborates with the education coordinators in the training of new coding employees
- Provides monthly summary to Senior Analyst of review activities and findings
- Provides input in the development, refinement and implementation of methods and procedures used to complete review functions
- Contributes to the development of educational/training opportunities for physicians and hospital clinical staff
- Participates in committee work and cross functional teams as needed by department management
- Assists manager with the processes associated with the weekly DNFB to consistently meet entity/system targets; provides back up coverage for coding staff as needed
- Analyzes and adjusts workload responsibilities based on changes in staffing/volumes etc
- Monitors and resolves the Stockamp QUIC queues pertaining to DRG reviews according to schedule
- Assists with requests to verify and review codes; charges on patient accounts and denials
- Assists manager in monitoring and reporting coder productivity
- Assists coding staff in resolving ITS issues impacting work efficiently; facilitates ticket submission,
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Analyst / Healthcare Therapy Coding Analyst Resume Examples & Samples
- Research and understand novel device markets, including major competitors, uses, and product segmentation·
- Respond to client requests in a timely fashion, often requiring the Analyst to solve novel problems for which there is no standard process
- Build SKU/Code catalogs quickly and accurately
- Evaluate data outputs for market trends and draw insights, find potential errors and misses
- Market modelling and analysis
- Managing key DRG clients in the medical device space
- Presenting research findings to Internal and external stakeholders
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Epic Coding Analyst Senior Resume Examples & Samples
- Development of educational programs, monitoring tools and audit reports used in tracking and reporting of HCC
- Develop systems to communicate changes in diagnosis coding requirements to other staff
- Create action plans that may include documentation of procedures, education, and system enhancement
- Using vendor system, and other local systems, responsible for development of tools used to track HCC scores and develop reports for coding analyst and provider educators
- Perform chart review to determine completeness of charts HCC data
- Assists users in answering questions and working with physician champion group, to develop and sustain provider educational programs related to HCC coding and documentation
- Assists compliance analysts in educational process and audit tools used in HCC review process
- Supports all systems processes related to HCC coding including, but not limited to
- Minimum of five (5) to seven (7) years coding, application support, IT, or related experience required; minimum of one (1) to two (2) years’ experience in clinical setting or healthcare business office setting preferred
- Strong knowledge of HCC coding requirements and reporting
- Knowledge of CMS regulatory process and rules related to outpatient billing systems/processes. Medical Terminology background
- High level understanding of CPT, ICD-9 and ICD-10, HCPC coding guidelines
- Strong background across a wide range of medical record review processes, including
- Ability to work independently and establish priorities
- Ability to lead educational presentations, provide project management, design and analysis as a part of projects assigned
- Ability to work well with team members and clinical personnel
- Ability to analyze, problem solve and make appropriate decisions in performance of HCC compliance audits
- Requires the ability to establish priorities and coordinate several activities at the same time
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Coding Analyst Resume Examples & Samples
- Codes Inpatient, Observation and Same Day Surgery medical records in accordance with ICD-9-CM and CPT-4 classification systems. Analyzes medical records to retrieve diagnosis, operative procedure, and complication information
- Interprets patient charts to determine Diagnosis Related Group (DRG) and/or Ambulatory Patient Classifications (APC) and Ambulatory Surgery Categories (ASC) assignment for Medicare and Medicaid reimbursement. Analyzes on-line query information to retrieve diagnosis and code appropriately. Contacts physicians when necessary for additional information regarding patient diagnosis; obtains additional signatures and approvals in complicated cases where multiple diagnoses may be necessary to facilitate reimbursement
- Reviews physician documentation in patient record for all Inpatient, Observation and Same Day Surgery patient visits, retrieving diagnosis, operative procedure and complication information
- Enters and views information into and from the computer systems; maintains accurate data base file
- Assists QMI Department and Medical Record Committee with data retrieval based on established criteria
- Safeguards confidentiality of records according to state and federal regulations and hospital and departmental policy
- Adheres to all Northwest Community Hospital standards, policies and procedures
- CB
- Associate’s degree in healthcare required. Bachelor’s degree in healthcare preferred
- Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), or Certified Professional Coder (CPC) required
- Certification of Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred
- Two years medical record coding experience, with a proficiency in coding of Inpatient, Observation and Same Day Surgery patient types in a hospital setting required
- Achieve satisfactory score on NCH HIM coding test
- Demonstrated knowledge of clinical information
- Experience with computerized encoding systems
- The analytical skills necessary to accurately code information per national coding guidelines
- The computer skills necessary to store, retrieve and view data from a health information system
- The organization skills to perform consecutive detail-oriented tasks accurately
- The reading skills necessary to decipher physicians’ handwriting
- The interpersonal skills necessary to interact with physicians, staff and others who request information from the department
- Successful completion of Anatomy and Physiology modules and proctored exam
- Successful completion of ICD-10-CM and PCS training modules and proctored exam
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Coding Analyst Resume Examples & Samples
- Codes Emergency Department (ED), Immediate Care Center (ICC) and/or ancillary area medical records in accordance with ICD-9-CM and CPT-4 classification systems. Analyzes medical records to retrieve diagnosis, procedure, and complication information. Assigns Ambulatory Patient Classifications (APC) for Medicare and Medicaid reimbursement
- Enters and views information into and from the computer systems. Maintains accurate data base files
- Reviews physician documentation in patient record for all ED/ICC patient visits. Assesses documentation for completeness and determines appropriate Evaluation and Management (E/M) levels based on physician documentation of nature of patient problem presented, severity, assessment of patient history, type of examination conducted, complexity of services administered and medical decisions provided, patient consultation, and coordination/duration of care. Utilizing hospital and regulatory guidelines, determines classification for physician charging levels and enters data into the hospital information system (HIS)
- Reviews NCH clinical staff documentation in patient record for all ED/ICC and ancillary area patient visits. Analyzes patient documentation for all hospital/facility-related medical supplies, nursing assessment and intervention related services provided. Translates clinical documentation into a point system to determine hospital charging levels utilizing patient classification and ED facility fee guidelines. Enters all patient service charges associated with levels into the hospital information system
- Reviews NCH physician and clinical documentation for all ancillary/other patient visits assigning appropriate diagnosis codes
- Certified Coding Specialist (CCS) or Coding Specialist-Physician based (CCS-P) or Certified Professional Coder (CPC) or recent Health Information Management (HIM) degree graduate who is required to earn RHIT credential within one year of hire
- Achieve satisfactory score on HIM coding test
- Previous medical record coding experience in a hospital or physician office setting strongly preferred
- Professional and/or facility E/M leveling experience preferred
- Successful completion of Anatomy and Pathophysiology modules and final proctored exam
- Successful completion of ICD-10-CM course modules and final proctored exam
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Coding Analyst Resume Examples & Samples
- RHIA, RHIT, or CCS or eligible for certification or possesses extensive hospital based coding knowledge/experience
- Two years ICD-9-CM/CPT/DRG/APC experience in a Medical Record Department except for a trainee position
- Knowledge of medical terminology, anatomy and physiology, and disease process is needed
- College degree or allied health courses required
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Health Care Coding Analyst Resume Examples & Samples
- Abstracts medical information from hospital medical records according to standard procedures and national/regional medical coding guidelines, rules, and regulations
- Serves as a liaison between University physicians, hospitals, and billing units
- Makes recommendations for policy and procedural changes as they relate to hospital medical billing
- Enters billing data abstracted from medical records to appropriate billing systems
- Assists in determining policy and procedure pertaining to medical coding
- Conducts training under direction of the Health Team Central Business Office
- Utilizes on-line Medicaid resources in order to remain current on regional carrier decisions affecting coding determinations
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Coding Analyst / SHH Emerald Coast / Days Resume Examples & Samples
- Obtains acceptable productivity/quality rates as defined per coding policy
- Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
- Two years of experience in hospital coding, physician billing or reimbursement required
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Coding Analyst Resume Examples & Samples
- Current certification as a professional coder - Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC)
- Current certification as Certified Risk Adjustment Coder (CRC) or must be willing to obtain CRC within 1 year of hire
- 3 years of experience as a RHIA, RHIT or CPC certified coder within a healthcare provider organization or health insurance company
- Demonstrated experience in project completion, educational program development and/or group presentation
- Baccalaureate degree -or-
- Equivalent work experience in a Healthcare setting may be considered
- Addition of Certified Coding Specialist- Physician (CCS-P), Certified Coding Specialist- Hospital (CCS-H) Certified Professional Coder-Payer (CPC-P) and Certified Professional Coder-Hospital (CPH-H) certification
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Coding Analyst Resume Examples & Samples
- Performs ongoing critical assessment of coding CPT and diagnosis assignment on all types of specialties to include assessment for accuracy, and compliance with Coding Guidelines. Abstract pertinent information from patient records and assigns ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and/or HCPCS codes, Review claims, ensure accurate charge capture and review medical necessity for all. Follows guidelines for coding and documentation to ensure physicians and hospital compliance. Remains current with coding information to ensure accuracy of codes assigned based on documentation. Guides, supports, and sponsors concurrent clinical coding. Provides clinical interpretation of physician documentation. Acts as a liaison between the clinical and coding functions
- Serving as a resource for coding functions in the Medical Claims Review Unit to ensure proper level of coding and payment of medical claims. Understanding ICD-9 codes and how they will translate to the new ICD-10 code set. Strong knowledge of the GEM mapping. Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine. Evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate CPT assignment
- Responsible for ensuring the accuracy and completeness of clinical coding; validating the information in the databases for outcomes management
- Demonstrate expertise in ICD-10-CM/PCS coding to act as a resource for the education of provider, nursing, and healthcare staff, as well as new employees
- Research, review, and analyze new medical procedures, technology, equipment, and corresponding CPT/HCPCS (Healthcare Common Procedure Coding System) codes; gather input from providers; recommend coverage and reimbursement levels consistent with state and federal policies. Working knowledge of AMA Coding guidelines, working knowledge in the assignment of ICD-9-CM codes Volumes 1 based on Coding
- Responsible for managing the Annual/Qtrly procedure and diagnosis code set update coverage assessment and subsequent RPC presentation. Responsible for preparing/presenting Reimbursement Policy change documents required as a result of research performed on coding and policy inquiries from Provider Reimbursement, Provider Network Management and other departments
- Reviews and examines entire current operative report, pathology, E/M OBGYN, oncology, ENT among other specialties for accurate and complete diagnostic and procedure information. Understands and implements coding guidelines for multi-specialty practices and/or complex coding cases
- Regular attendance is an essential function of the job. Performs other duties as assigned or required
- Review, translation and documentation of CMS GEM (General Equivalency Mapping) crosswalk /mapping; which includes but is not limited to identify code mapping strategies, gap analysis, and developing recommendations on how to resolve cross-walk deficiencies
- Review clinical documentation and accurately identify CPT and Dx codes that should be used on the claim
- Research Medicare reimbursement policies
- Research industry standards reimbursement policies
- Must have working knowledge of ICD-10 impacts and implications to healthcare providers
- Minimum 5 years of coding experience
- ICD-10 AAPC or AMA certification AND CCS (AHIMA Certified Coding Specialist), CPC (AAPC Certified Professional Coder), &
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Coding Analyst Resume Examples & Samples
- Minimum High School Diploma or GED
- Effective analytical/problem solving skills
- Ability to multi-task and the ability to be flexible and to work overtime as needed
- Ability to analyze, research, and find viable solutions to problems and implement solutions in a timely manner
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Coding Analyst Resume Examples & Samples
- Successful completion of AAPC Certified Professional Coder Exam required
- Minimum three years medical coding experience required
- Proficiency with computer systems and MicroSoft (Office Outlook, Word, Power Point, and Excel) required
- Prior oncology experience preferred
