For the department of Otolaryngology, the Coding Specialist III will be responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Responsible for developing coding and billing change procedures. Responsible for training on all coding and billing changes.



Principal Duties & Responsibilities



Procedural Knowledge

Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
Works closely with Office of Billing Quality Assurance to include review of documentation.
Serves as departmental expert on coding questions.
Exercises independent judgment and decision making on a regular basis with respect to code selection.
Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies.
Research and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
. Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
. Review and resolve Epic Charge Review Edits daily.
. May act as a backup to Charge Entry when needed.
. Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.
. Works with Department Management to create Charge Review Rules to prevent unnecessary denials.
. Works with Department Management on maintenance of provider preference lists.
. Provides training on all coding changes to providers and staff. Develops presentations to effectively communicate how changes will affect provider billing and coding. Provide face to face training on changes to providers based at all Hopkins locations.
. Conducts monthly internal audits for level I and II coders.


Technical Knowledge

Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of JHU/ PBS Billing Applications.
Utilize online resources to facilitate efficient claims processing.
Capable of advance problem solving in medical billing and coding.


Professional & Personal Development

Participate in on-going educational activities.
Assist in the training of staff, providers, management and administration.
Keep current of industry changes by reading assigned material on work related topics and provide updates to providers, staff, management and administration.
Complete three days of training annually.


Service Excellence

Must adhere to Service Excellence Standards.
Customer Relations.
Self-Management.
Teamwork.
Communications.
Ownership/Accountability.
Continuous Performance Improvement.


Supervision of Others

May assist in directing the activities of coding staff or a function relating to the training of new coding staff in coding applications.