Coding Integrity Specialist Jobs Near Me

At Mount Carmel, we're committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care.

Job Summary In accordance with the Mission and Guiding Behaviors; the Physician Coding Specialist II will assign the appropriate surgical and office procedural and diagnostic (CPT - E/M, surgical and ICD) codes to individual patient health information for data retrieval, analysis and claims processing for the Mount Carmel Medical Group (MCMG). This position utilizes advanced knowledge of specialty coding, including surgical procedures. The coding specialist will abstract pertinent data and resolve edits within specified time frames.

Specialty: Cardiology / OBGYN focus

Job Qualifications (Knowledge, Skills, and Abilities) • Education: High School diploma or equivalent required. • Licensure / Certification: Certification in coding (CPC, COC, CCS, CCS-P, RHIA, RHIT) required. Certification in coding of physician services (CPC, CCS-P) preferred. • Experience: Formal training in CPT and ICD coding or previous work experience utilizing ICD and CPT coding principles is required. • Effective Communication Skills • Minimum one year of physician office coding experience required. • Ability to analyze, interpret and assimilate information from various sources based on technical and experience-based knowledge. • Comprehensive knowledge of procedure and diagnostic coding for professional services and Medicare, Medicaid and other 3rd party payer coding and billing regulations. • Demonstrated knowledge of Evaluation and Management Documentation Guidelines and other professional documentation requirements. • Self-motivated and people-oriented with the ability to foster a work environment of open communication, trust, support and active employee participation.

Essential Responsibilities

• Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service. • Meets population specific and all other competencies according to department requirements. • Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients. • Relationship-based Care: Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system. • Reviews and evaluates patient medical records to determine the level of Evaluation and Management (E/M) service, identify office non-E/M procedures, surgical and interventional procedures and diagnoses. Accurately assigns and sequences CPT, modifiers and ICD codes. Abstracts and validates information. • Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes. • Keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to manager. • Monitors, investigates and takes appropriate action for records that are not coded, billed or rejected • Attends educational opportunities to enhance knowledge in coding and reimbursement systems and obtains/maintains certification from AHIMA or AAPC to validate coding skills. • Abides by the Standards of Ethical Coding as set forth by the National Coding and Credentialing Bodies. • Communicates documentation discrepancies, coding definitions, and questions to the medical staff and patient accounting for clarification in a professional and courteous manner. • Responsible for enhancing coding skills to enable accurate and timely coding. • Meets or exceeds department productivity and quality standards for coding and abstracting. • Verifies and corrects information in a timely manner and reports correction to the Central Billing Office.

Other Job Responsibilities • Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing. • All other duties as assigned

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.