Coding Account Resolution Specialist

Coding Account Resolution Specialist Ii (Cars-Ii)

The Coding Account Resolution Specialist II (CARS-II) is responsible for resolving outpatient coding-related alerts and edits for Same Day Surgery (SDC), Observation (OBV), Wound Care, and Outpatient Cardiology accounts, primarily post initial/final coding. This role ensures accurate account resolution, compliance with coding standards, and timely communication to prevent billing delays.

Key Responsibilities:

• Compile and manage daily worklists from eRequest, CRT, and/or other alert/edit systems.
• Review and resolve alerts/edits for: Same Day Surgery (SDC), Observation (OBV), Wound Care, and Outpatient Cardiac Cath.
• Provide backup coverage for Emergency Department (ED), Recurring (RCR), Clinical (CLI), and Provider Office Visit (POV) accounts.
• Document detailed notes in eRequest when alerts/edits cannot be resolved or need rerouting.
• Escalate issues as necessary to avoid billing delays.
• Monitor aging accounts, prioritize resolutions, and report trends to leadership.
• Collaborate with billing, revenue integrity, and Medicare Service Center teams to resolve complex edits.
• Communicate coding revisions to appropriate stakeholders.
• Assist Coding Leads/Managers with unbilled reason codes (URCs).
• Complete MOCK abstracts when required.
• Maintain compliance with CMS, AHA, and company coding/billing guidelines.
• Participate in ongoing education to maintain current coding knowledge.
• Perform additional duties as assigned.

Required Knowledge, Skills & Abilities:

• Strong knowledge of ICD-10-CM, CPT/HCPCS, and reimbursement methodologies.
• Proficiency with Meditech/Meditech Expanse, 3M/Solventum encoder, HPF/MPF, and Microsoft Office (Excel proficiency required).
• Ability to manage multiple priorities efficiently and work independently.
• Strong analytical and problem-solving skills.
• Excellent communication, organization, and decision-making abilities.
• Demonstrated ability to collaborate effectively with cross-functional teams.

Qualifications:

• Education: High school diploma or GED required; Associate or Bachelor's in HIM/HIT preferred.
• Experience: Minimum of 3 years of facility outpatient coding, including SDC, OBV, IVR, Cardiology, and Wound Care.
• Certification: RHIA, RHIT, or CCS preferred.