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Job Details

Coding Claim Edit Specialist

Requisition #: 472365
Location: Johns Hopkins Hospital, Baltimore, MD 21201
Category: Coding
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: No
Date Posted: April 1, 2022

Join an amazing global healthcare organization!

Excellent compensation package!

Awesome benefits, including dependent tuition reimbursement!

Requisition #: 472365

Location: 3910 Keswick Road, Baltimore, MD 21211

Shift:

Full Time (40 hours)

Day Shift, 7:30 am - 4:00 pm

Exempt

Position Summary:

This position is responsible for an intermediate level of analyzing, reviewing and resolving billing denials for medical necessity or any other coding specific facility specific denials. The Specialist will review medical record documentation to assure services are billed with the appropriate diagnosis and procedures, will assign the appropriate ICD-9, CPT, and HCPCS code as documented for accurate claim submission to bill appropriately for all services provided. The Technical Coding Specialist will serve as an intermediate level resource for the Patient Financial Services department to assist with coding guidance. As appropriate, may assign billing modifiers to assure correct reimbursement. In an effort to optimize reimbursement and reduce denials, the Technical Coding Specialist will communicate findings and provide the necessary education for clinical departments and business office staff on coding and billing guidelines. The Technical Coding Specialist will also gather relevant denial trends for presentation to management and make recommendations for improvement.

Critical to this position is the ability to research applicable documentation and reimbursement policies to resolve billing denials, identify trends/problems in billing and documentation, draft written reports which document denial trends and recommendations, articulate findings to JHHS Management, appropriate Departmental personnel and other internal customers and coordinate and track Department initiated corrective actions where necessary.

The Technical Coding Specialist works as team member and positively accepts change throughout the Health System while establishing relationships environment and payer contracts as needed.

Education:

Associates Degree required. Experience beyond the work experience requirement may be substituted for the degree on 2 years of experience for 1 year of education basis .i.e. 4 years

Work Experience:

3-5 years of experience in outpatient coding.

Required Licensure, Certification:

Certification in Coding: CPC, CCS or COC Health care-related licensure or certification in nursing or other clinically related fields.

Knowledge:

  •  Requires the basic ability to read and analyze a hospital patient medical record as it relates to clinical documentation and diagnostic/procedural coding of the services provided.
  •  Requires an understanding of third party hospital guidelines and government billing and coding regulations.
  •  Requires the ability to identify through investigation and analysis, underlying causes and contributing factors to areas of weakness, making appropriate recommendations.
  •  Requires knowledge of current regulatory requirements related to Medicare and Medicaid billing including coding and documentation standards and guidelines.
  •  Requires knowledge a comprehensive understanding of insurance claim filing and billing principles. Familiarity with the Maryland regulatory environment is preferred.
  •  Requires current and continued knowledge of ICD10CM, CPT, and HCPCS and coding terminology as it relates to facility billing.
  •  Requires basic knowledge of anatomy, physiology and medical terminology.
  •  Intermediate use of Microsoft Office.

Skills:

  •  Requires interpersonal, oral, and written communication skills; the ability to interact and communicate effectively with all levels of management, including senior management is essential.
  •  Demonstrated ability to research and understand billing and compliance regulations.
  •  Requires the ability to plan and prioritize multiple tasks without supervision.
  •  Requires analytical abilities in order to effectively monitor billing and other issues and reports thereon.
  •  Ability to understand concepts and apply them on subsequent claims and issues.
  •  Ability to communicate concisely and effectively to educate clinical areas on billing/coding issues.
  •  Requires analytical skills to identify issues and trends in billing.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.

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