The Coding Specialist is responsible for analysis and review of medical record documentation, accurate coding, accurate review of CCI edits, research and compliance with federal regulations by diagnosis assignment of ICD-10 and/or CPT codes for outpatient medical services as indicated. Also responsible for researching newly identified diagnoses and/or procedures for code assignments and performing related miscellaneous duties as assigned.

Schedule: Full-time, Monday-Friday (1st shift)

Work environment: Fully on-site for the first 90 days for training purposes, eligible to become fully remote afterwards based on productivity levels. Staff required to attend on-site meeting once per month.

Location: 3700 Corporate Drive

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children's Hospital, Where Passion Meets Purpose.

Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

We're 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we'll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

Ask anyone with a Nationwide Children's badge what they do for a living. They'll tell you it's More Than a Job. It's a calling. It's a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

Nationwide Children's Hospital. A Place to Be Proud.

Utilizing 3M, CPT, and ICD-10-CM coding books/software assigns CPT and/or ICD-10-CM codes to medical services or charges.
• Completes required research to ensure compliance with CCI edits - CPT and ICD-10 coding standards.
• Utilizes EPIC workflow to review account CCI edits and resolves as appropriate
• Perform charge reconciliations to ensure all charges are being captured.
• Maintains updated knowledge of coding requirements; including continuing education and certification renewal.
• Reviews and performs necessary coding and billing corrections for all insurance coding and medical necessity denials.
• Assists the billing staff with coding questions.
• Consistently meets the department specific standards for quantity standard.
• Consistently codes 95% accuracy rate or better (quality standard).
• Utilizes Internet and other resources to research newly identified diagnosis and/or other procedures.
• Researches CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
• Acts as a liaison between the denials team, billers, clinical staff and leadership in resolving billing and reimbursement issues.
• Conduct billing and coding compliance documentation review, which may include review of out-patient medical records to determine appropriateness of procedure and diagnosis coding, as well as, evaluation and management coding.
• Conduct analysis and be able to apply state and federal healthcare or related regulations to different questions, projects or inquiries.
• Conduct coding and billing education sessions with the practitioners and other staff who may be involved in coding and billing.
• Handle inquiries from the department's customers on billing and coding compliance-related questions.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

* High school diploma or equivalent

* RHIT, RHIA, CCS, CCA, CPC or COC certification required

* Good working knowledge of medical terminology and anatomy

* Must possess high degree of professional competency for coding, accuracy in all details

* Must possess a self-directed work ethic

* Strong problem-solving, collaboration and interpersonal skills

* Ability to work effectively and professionally under pressure

* Ability to maintain and establish strong working relationships with physicians and support staff

* Intermediary skills in MS Office: Word, Excel and Outlook required

* Previous professional or facility coding experience (5+ years) with documented education in anatomy, physiology, and medical terminology required

* Working knowledge of EPIC preferred

* Pediatric coding and billing a plus

* Ability to handle multiple tasks and priorities and deadlines

* Analytical and organizational skills a must for analyzing clinical information and data

* Effective communication and interpersonal skills required with ability to work with physicians and other caregivers regarding coding issues

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

EOE M/F/Disability/Vet