Remote Professional Medical Coder - Office ENT (remote)

📋 Description

• • As a Remote Professional Medical Coder specializing in Office ENT (Ear, Nose, and Throat) services, you will play a critical role in ensuring accurate medical coding and billing practices for a leading healthcare organization. This fully remote position requires a deep understanding of Evaluation & Management (E/M) services and in-office procedures specific to ENT cases.
• • Your primary responsibility will be to meticulously review clinical documentation, including physician notes, operative reports, and diagnostic results, to extract relevant data. This data will then be used to apply the appropriate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes, aligning with the specific service type being billed.
• • The codes you assign will be crucial for various functions, including accurate billing to payers, internal and external reporting requirements, supporting research initiatives, and ensuring strict regulatory compliance with all applicable healthcare laws and guidelines.
• • You will operate under the direction of the coding manager, adhering to established coding standards and guidelines. This includes mastering and applying the ICD-10-CM Official Guidelines for Coding and Reporting, understanding and implementing Medicare Administrative Contractor (MAC) rules, and following the CPT rules established by the American Medical Association (AMA).
• • A significant aspect of your role will involve analyzing coding-related denials received from various payers. You will investigate the root cause of these denials and recommend the most appropriate course of action to resolve the claim, ensuring compliance with individual payer guidelines and policies.
• • You are expected to maintain a comprehensive and up-to-date working knowledge of ICD-10 and CPT coding principles. This includes staying abreast of governmental regulations, official coding guidelines, and the specific documentation and billing requirements mandated by third-party payers.
• • A key performance indicator for this role is the assurance that all services documented in a patient's chart are accurately coded. If documentation is found to be insufficient or unclear, you will proactively seek clarification and proper documentation from healthcare providers in a timely manner, following facility-specific standards.
• • You will be tasked with achieving and consistently maintaining a coding accuracy rate of at least 95%. This accuracy will be regularly monitored and reviewed during monthly performance evaluations. Alongside accuracy, maintaining high productivity standards is essential to meet organizational goals.
• • Daily, you will manage and work the review queue, ensuring all charts assigned to you are processed promptly. Any necessary corrections identified during this process must be communicated effectively to the facility for implementation.
• • You will be responsible for correcting charts that require re-billing and communicating these to the facility daily, following the established re-bill policy and procedures.
• • Promptly reporting any coder downtime to administrative staff is crucial to ensure that turnaround times for coding assignments are consistently met.
• • Collaboration with the Internal Quality Control (IQC) staff is vital to ensure that quality standards are being upheld for each assigned facility.
• • You will be expected to provide accurate and timely answers to coding and/or billing questions posed by physicians and hospital staff, responding within eight hours of receiving a request.
• • Every chart placed in your queue must be coded or pended within a strict 24-hour turnaround time. If there is any risk of not meeting this standard, you must notify administrative staff immediately.
• • Regular monitoring of the Guidehouse email system is required, checking at least every two hours during your coding sessions to stay informed of communications and updates.
• • Maintaining your current professional coding credentials (e.g., CPC) throughout your employment with Guidehouse is a mandatory requirement.
• • Familiarity with and active use of the Guidehouse coding website is expected, utilizing the resources available as a daily tool for accurate coding and abstracting for each facility.
• • You must maintain a HIPAA-compliant workstation, adhering strictly to all relevant policies and procedures.
• • Reviewing and diligently adhering to the content of the coding division policy and procedure manual is essential for consistent and compliant work practices.
• • You will work collaboratively with other members of the facility's coding and billing team to ensure maximum efficiency and appropriate reimbursement for all properly documented services.
• • Immediately communicating any problems, concerns, or discrepancies in coding principles to your supervisor is critical for prompt resolution and maintaining high standards.