Coding Specialist

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

Purpose:

Provide guidance and instruction regarding insurance coding protocol to ensure compliance with regulatory requirements.

Essential Duties/Responsibilities:

• Serve as a technical resource for all coding and billing regulations for provider services
• Assist in formulating policies and procedures regarding coding and billing to ensure consistency and compliance across all clinic departments
• Interact with medical staff and clinic staff to ensure quality and consistency with coding and billing policies
• Perform quality control reviews of internal audits
• Work with designated clinic administrative staff in identifying and addressing significant coding/billing issues. This may include initiating policy changes and/or identifying areas in need of corrective action plans and assist in development and execution of actions plans
• Educating and training of clinic staff and medical staff
• Review and update clinic fee schedule on an annual basis
• Review and update of encounter forms/charge tickets on an annual basis
• Perform Evaluation and Management (E/M) profiling on a monthly basis

Other Duties:

QUALIFICATIONS

• High school diploma or equivalency

Required :

• 3-5 years health insurance experience, Certified Coder
• CPC, CCS-P

Preferred:

• Abstract coding experience

Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran's status, sexual preference, disability, genetic information, or any other class protected under state or federal law.

ADA Physical Demands:

Rarely (Less than .5 hrs/day) Occasionally (0.6 - 2.5 hrs/day) Frequently (2.6 - 5.5 hrs/day) Continuously (5.6 - 8.0 hrs/day)

Physical Demand

Required?

Frequency

Standing

Rarely

Sitting

Frequently

Walking

Occasionally

Kneeling/Crouching

Lifting

Coding Specialist Competencies

General

1. Customer Service
2. Professionalism/Integrity/Responsibility
3. Teamwork/Process Focus
4. Dependability/Punctuality
5. Interpersonal Relationships/Communication
6. Judgment/Decision Making/Problem Solving
7. Quality/Quantity
8. Initiative
9. Safety and Housekeeping
10. Organizational Skills/Time Management
11. Quality Management
12. Cost Consciousness
13. Motivation
14. Innovation

Department Specific

1. E/M audits monthly and review with physician
2. PRM -- add new prices, make sure codes are updated annually; update ICD-9 file annually
3. Update charge sheets annually and as needed
4. Update Experior when patients re dismissed from practice or from individual physicians and talk to patients with questions
5. Read monthly Medicare, Medicaid, and coding bulletins; update appropriate staff and physicians
6. Be available to staff and providers for coding questions
7. Special project audits--i.e., shared visit documentation, Medicare audit requests, patient complaint audits