Clinical Coder III Job in Gainesville, Florida

The incumbent for this position performs highly technical and specialized functions for the Department of Orthopedics and Rehabilitation at the University of Florida, College of Medicine. This position assures that all E&M and Surgical procedure services are captured, coded and billed. Implements procedures and systems for capturing all appropriate physician reimbursement. Recommends changes to front-end processes to improve efficiency and accuracy of revenue process. The employee reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. The coder is also responsible for training physicians and other staff regarding documentation, billing and coding and for providing feedback to physicians regarding billing practices. 25% - Review codes assigned by physicians, or assign the appropriate, ICD-10, ICD-9 and CPT codes based on reports and/or progress notes provided by physicians. Assist providers with coding education and feedback to improve their accuracy in code selection. 15% - Ensure continuous quality improvement of physician coding and team billing practices. This includes review of and recommendations for ICD-10; ICD9/CPT coding to ensure compliance with policies for coding and claim submission. 15% - Monitor that reimbursement levels are appropriate, especially in areas that are at risk for improper reimbursement. Analyze and propose opportunities in the managed care contracting process. 15% - Ensure clean claim submission by resolving system edits for inpatient and outpatient hospital services and doctor's office edits when applicable. Review and analyze rejections to determine trends; propose solutions for change in process as appropriate. Identify payer-specific trends and provide support to resolve claim issues. 10% - Participate in group discussions and problem resolution activities pertaining to the division and department; proactively serve as a resource for providers for coding/compliance issues. Work collaboratively with providers, peers, payers and others. 05% - Track and resolve provider enrollment issues for new providers. Work with others to ensure that billing numbers are received and A/R is released for timely payment. 05% - Demonstrate a working knowledge of Managed Care processes. Stay abreast of annual coding updates. 05% - Act as a resource to front-end staff to prevent unnecessary denials or non-payment for services rendered. Shannon 05% - Identify issues that make a financial impact across the organization. Minimum requirements include a high school diploma or equivalent and five years of experience in professional medical coding, with experience in two or three clinical specialties. Appropriate college coursework or vocational/technical training may substitute at an equivalent rate for the required experience.Certified Professional Coder (CPC)/ American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS-P) required. Preferred qualifications include advanced knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record. Advance knowledge of medical codes involving selections of most accurate and description code, using the ICD-9-CM/ICD-10-CM, Volumes 1- 3, CPT, HCPCS, and IHS coding conventions. Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-9-CM/ICD-10-CM code. Advance knowledge of medical codes involving selection of most accurate and descriptive code using the CPT codes for billing of third party resources. Knowledge of Epic (EMR, Cadence and Resolute) and HIS Electronic Health Record in order to analyze encounters and notify providers of data that needs corrections through EMR broadcasts, notifications and templates. Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data. Requires skill in the use of a wide variety of office equipment including: computer, typewriter, calculator, facsimile, copy machine, and other office equipment as required. Must be able to follow instructions and work independently. Salary for this position will be $21.55 - $25.38 per hour, commensurate with qualifications.