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Columbia University
Coding Specialist IIIColumbia University • Columbia University Medical Center
Coding Specialist III

Coding Specialist III

Columbia University • Columbia University Medical Center
8 days ago
Job type
  • Full-time
Job description

Position Summary

The Coding Specialist III is responsible for the review and resolution of all coding related prebilling edits and/or rejections to ensure prompt and accurate reimbursement. This position initiates medical record review and recommends proper action. This position works closely with the Directors of Revenue and Practice Operations to adjudicate and resolve claims.

Responsibilities

  • Review and resolve all assigned tasks/encounters associated with coding discrepancies as it relates to pre-billing system edits and/or claims with outstanding balances.
  • Reduces accounts receivable by reviewing claims rejected for coding. Investigates assigned accounts to determine what additional steps must be taken for claims to be resolved.
  • Provide guidance and suggestions to clinical departments for pre-billing coding edits.
  • Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the hospital.
  • Review and follow up on denials related to coding and charge entry processes; if a claim is denied due to incorrect coding, conducts medical records research and corresponds with insurance companies and clinicians to resolve issue.
  • Manages appeals with insurance companies for surgical claim reimbursement when appropriate.
  • Assess clinical documentation supporting services.
  • Oversee to insurance coding requests.
  • Assists with claim issues, including preparing coding appeals.
  • Serves as liaison between clinicians, billing consultants, patient financial counselor and insurance carriers to discuss coding issues.
  • Review and analyze coding trends to improve unnecessary coding rejections.
  • Create new edits related to payors and CMS guidelines to release to clearing house.
  • Trains new coders and billers.
  • Support other functions as assigned.

Minimum Qualifications

  • Bachelor's degree or equivalent in education and experience.
  • Three years of related experience.

Preferred Qualifications

  • Certified Professional Coder (CPC).
  • Intermediate MS Office skills.
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Coding Specialist III • Columbia University Medical Center

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