Position Summary:
The Clinical Documentation Specialist for Professional Billing (PB) conducts billing integrity reviews/audits, including reviewing billing submitted with all supporting clinical documentation to assess the extent to which applicable documentation and coding criteria have been met and to identify clinical documentation improvement opportunities. The incumbent assists in the production/delivery of education/training to providers and staff related to clinical documentation improvement, coding, billing regulations and standards; assists with quality assurance audits; produces reports on findings; researches billing compliance related questions and prepares complete and accurate responses and keeps current on all related regulatory matters.
Travel of up to 70% of the work week is expected with intermittent overnight stays depending on need.
Minimum Requirements:
Two (2) years of ICD-10 CPT coding experience in an outpatient and/or inpatient setting required
Experience in Microsoft Excel and Word
Experience in payor denial management and appeals process preferred
Education/Licenses/Certifications:
Post secondary coursework in medical science and coding preferred
Certification as a Certified Coding Specialist (CCS) or CCS-P or RHIT required
Certified Clinical Documentation Specialist (CCDI) preferred
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