Medical Coding Specialist

📋 Description

• • As a Medical Coding Specialist at Ensemble Health Partners, you will play a crucial role in ensuring the financial health of healthcare providers by accurately translating complex medical documentation into standardized codes. This remote position offers the opportunity to work from anywhere nationwide, contributing to our mission of keeping communities healthy by keeping hospitals healthy.
• • Your primary responsibility will involve meticulously reviewing medical record documentation to assign appropriate ICD-10-CM, ICD-10-PCS, CPT IV, and HCPCS codes. This requires a deep understanding of coding guidelines and the ability to apply them to various outpatient visit types, including ancillary services, urgent care, emergency department visits, observation stays, same-day surgeries, and interventional procedures.
• • You will be expected to adhere strictly to official coding guidelines, including those set forth by the American Health Information Management Association (AHIMA) Coding Ethics, the American Hospital Association (AHA) Coding Clinics, and directives from the Centers for Medicare & Medicaid Services (CMS).
• • A key aspect of this role is the accurate abstraction of specific data elements for each case, ensuring compliance with all federal regulations and payer requirements. This includes performing "medical necessity checks" for Medicare and other payers to ensure claims are processed correctly the first time.
• • You will utilize advanced coding software tools, such as 3M encoder and Computerized Assisted Coding (CAC) systems, as well as third-party software like LYNX for specific tasks such as applying Evaluation & Management (E&M) levels and documenting injections, infusions, and other requirements for observation cases.
• • This position involves actively monitoring and working accounts that are Discharged Not Final Billed (DNFB), failed claims, stop bills, and epremis. Your contribution to this team effort is vital for ensuring the timely and compliant processing of outpatient claims within the billing system.
• • Maintaining established productivity requirements and key performance indicators (KPIs) for coding accuracy and efficiency is essential. You will be responsible for meeting quality standards to ensure the integrity of our coding processes.
• • Staying current with the latest requirements from CMS, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), is paramount. This knowledge is critical for the correct assignment of modifiers, which directly impacts claim submission success.
• • You will be expected to maintain a high level of competency and accuracy while using all coding tools and reference materials. Any inaccuracies found in coding software or potential unethical/fraudulent activities must be promptly reported to HIM Management/Supervisors per compliance policy.
• • Continuous learning is a core value at Ensemble Health Partners. You will be required to attend all mandatory system, hospital, and departmental meetings, as well as educational sessions. Completion of required annual learning programs is essential for ongoing professional development and growth.
• • This role offers a competitive hourly pay rate between $20.45 - $24.70, based on experience, and provides opportunities for bonus incentives, paid certifications, and tuition reimbursement.
• • You will be part of an award-winning company recognized for its excellence in revenue cycle management and as a top workplace, fostering a culture of innovation, collaboration, and work-life flexibility.
• • Ensemble Health Partners is committed to empowering its associates by providing the tools and resources needed to thrive, including a comprehensive benefits package, a supportive culture, and opportunities for professional growth and recognition.