Physician Specialty Coder

Position summary
Works independently and functions at a high level, managing complex review and communication with department clinicians and contacts to ensure timely and compliant submission of charges. Assigns, sequences, validates, and/or edits codes for assigned specialty departments. Initiates, reviews, and/or edits physician queries in compliance with company policy, when appropriate. Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to ensure coding knowledge and skills remain current. Works with the Billing teams to ensure the daily workflow is complete and that all assignments are reviewed, submitted, and resolved with the highest degree of accuracy which may involve a high level of complexity.
Key responsibilities

• Performs complex ICD-10 and CPT review and validation or ASA coding for assigned specialty departments.
• Establishes and maintains working relationships with Physicians in order to resolve specific case issues, as well as general questions and or principles.
• Participates in coding and reimbursement training programs. Provides instruction and education to staff on accurate charge entry and medical record documentation.
• Develops and maintains professional skills and up to date knowledge of regulatory and compliance issues related to coding, documentation and billing.
• Participates in professional organizations and reviews current literature. Stays current on all coding and reimbursement rules, regulations, trends and new developments.
• Acts as a resource for the Shared Service Center, providing assistance with complex billing/coding systems and payment issues.
• Performs other tasks and projects, as requested, including procedural documentation, participation in quality and operational improvement processes.
• Maintains credentials and certifications for CPC on an annual basis.

Minimum qualifications
Education:

• Certified Professional Coder
• High School / GED required. Associates preferred.

Experience:

• 4 years of Physician Coding with 2 of those years with a specialty or multi-specialty focus.
• Knowledge of computerized billing system required.
• Knowledge of medical terminology, anatomy and physiology, pathophysiology, ICD-9/10-CM and CPT-4 or ASA classification systems, and regulatory agency requirements related to surgical specialties.
• Advanced knowledge of CCI, LCD and CMS PRVU, payer editing systems such as McKesson required. Preference for knowledge related to system integration.
• Computer literacy and healthcare statistics computation required.
• Excellent written and verbal communication skills in order to effectively deal with conflicting views and issues and mediate fair solutions.
• Ability to work with diverse internal and external constituencies.
• Ability to take responsibility and perform required tasks independently, as well as in a team environment.

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.