Revenue Cycle Medical Coder II (Professional Orthopedic Required)

Job Description

Job Description

Primary Purpose of the Position:
The Revenue Cycle Medical Coder II is responsible for assigning diagnosis, procedural, and modifier(s) codes for medical billing purposes which includes verification of charge capture. Position also performs a wide variety of duties, which may include coding accuracy and completeness prior to tickets being processed for billing, insurance filing, and revenue reporting. Monitors daily flow of charge tickets to ensure claim accuracy. This is not a Remote position as you will be expected to come into the Los Angeles Office.

Essential Duties of the Position May Include The Following:
• Reviews charge tickets, identifies and corrects errors, prepares tickets for review, including proper CPT and ICD-10 codes and proper linkage between the two.
• Abstracts all surgical and designated diagnostic procedures and assigns appropriate procedure codes and modifiers using the International Classification of Diseases (ICD-10) system, and the Physicians’ Current Procedural Terminology (CPT-4).
• Reviews and maintains Athena worklist claims on a daily basis.
• Consistently meets and exceeds daily productivity and quality standards.
• Effectively works on complex and escalated cases.
• Cross-trained; i.e coding different specialties.
• Reviews scanned paper charge tickets for accuracy and completeness of codes.
• Maintains and expands knowledge of Anatomy and Physiology, Pathophysiology, Pharmacology, and Medical Terminology as basic building blocks for ICD-10-CM coding.
• Compiles, reviews and performs data reports and other duties assigned by Management.
• Identifies trends and communicates to the management team with findings.
• Works and collaborates closely with Revenue Cycle Team Members, Clinician, Physician, Division Leadership and Management.
• Keeps current of coding requirements by reviewing payer guidelines and regulations.
• Maintains a log of coding errors and omissions for review with the management team.
• Stays current on coding and compliance regulatory requirements through professional membership literature, continuing education classes, support and networking groups.
• Maintains current knowledge of regulatory requirements by CMS NCCI and MUE edits, Medi-Cal/CCS policies, and certain Medicare requirements.

- Attends various meetings and professional development programs on a regular basis; makes recommendations for revisions and/or new departmental procedures under the direction of management.

• Maintains audit record systems for radiology department.
• Performs other related duties as assigned by Management.

Job Qualifications:
Knowledge and skill:

1. Coding Certification, CPC from AAPC or CCS from AHIMA
2. At least five (5) years of medical coding experience preferred.
3. Orthopedic Surgical Coding required
4. Ability to communicate in both written and verbal formats with internal and external stakeholders.
5. Ability to handle multiple tasks.
6. Knowledge of medical terminology, CPT and ICD-10 coding, CMS NCCI and MUE edits.
7. Familiarity with payer billing and reimbursement guidelines and regulations, including the ability read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).
8. Ability to meet deadlines and to follow assignments through to completion.
9. Ability to organize and manage time effectively.
10. Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA and PHI guidelines.
11. Ability to work independently and as a part of a larger team.
12. Microsoft Word, Outlook and Excel knowledge preferred.
13. Ability to prepare, file and maintain patient records, file reports, and other correspondence.

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.

Company Description

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.