Coder, Specialty Physician

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Under the direction of the Coding Compliance Manager, the Specialty Physician Coder plays a key role in reviewing and analyzing specialty coding and billing for charge processing. This role will be responsible for reviewing and accurately coding office, hospital, and surgical procedures for reimbursement and ensuring accurate and compliant medical coding for inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients. The Specialty Physician Coder will also work with the Coding Compliance Manager on discovered coding trends and irregularities and needed action items.

• Achievement of productivity standards as established by management.
• Achievement of quality standards as established by management. In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines, including the ability to review and natively code surgical operative/procedure reports.
• In adherence with standard work, follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs. Optimization opportunities include but are not limited to, working in the Follow-Up and Claim Edit work queues and analyzing denial trends.
• In adherence with standard work, provide ongoing and frequent communication/education to MCMF providers to maximize coding compliance and reimbursement. Follow Coding Compliance department branding standards when communicating with clinical partners and fellow business center teams and work collaboratively with Physician Billing Services Insurance and Customer Service Representatives to solve billing and coding issues. Perform monthly coding change report analysis/oversight on provider coding change trends and communicate/educate the providers, as needed.
• In adherence with standard work, work weekly Missing Charge Reports to identify missed billable charges to maximize reimbursement.
• In adherence with standard work, organize, attend, and participate in specialty provider meetings. Prepare presentation materials for meetings, document meeting minutes, follow up on important action items/decisions from meetings, and report to the Coding Compliance Manager.
• In adherence with standard work, take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
• “Other duties as assigned.”
• 3 years’ experience working in a hospital or physician’s office as a medical coder and interacting with physicians.
• 1-years’ experience as a specialty coder in one of the following specialties: Cardiology, Gastroenterology, Medical Hematology/Oncology, OBGYN, Pulmonology, or Radiation Oncology.
• Expert knowledge of ICD10, CPT, and HCPCS.
• Strong knowledge of medical terminology, anatomy and physiology.
• Epic software experience is highly desired.
• Proficient Microsoft skills.
• High School diploma or GED required.
• CPC, CCS, or equivalent certification required.
• Specialty coding certification is highly desired.