Sr. Medical Coding Specialist

Role Summary:

The RCM Senior Medical Coding Specialist, under general supervision, performs daily charge review of visits, diagnoses, radiation oncology services, and surgical procedures to ensure accurate coding, documentation support, and compliant charge entry. This role serves as a coding resource for team members by helping answer coding questions, assisting with complex coding scenarios, and supporting consistent application of coding guidelines. The Senior Medical Coding Specialist also trains new coders joining the team while continuing to perform the core duties of the Medical Coding Specialist, including entering charges into the practice management system or EMR and auditing physician, APP, and clinical oncology staff documentation for correct coding of CPT, ICD-10, HCPCS, and modifiers.

Responsibilities:

• Keep informed regarding current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the field of oncology, medical coding, and effectively applies this knowledge.

• Assists with third party payor and other audit requests by compiling, organizing and reviewing chart documentation as needed.

• Works with other coders in the department to assist with difficult cases.

• Serves as a senior coding resource for team members by reviewing and responding to coder questions, providing guidance on complex coding scenarios, and helping ensure coding decisions align with current guidelines and payer requirements.

• Supports onboarding and training of new coders by explaining department workflows, coding expectations, system use, and escalation processes to promote accurate and consistent coding practices.

• Performs E&M and CPT coding review and other projects related to physician coding compliance in fulfillment of the practice’s compliance program.

• Assists practice leadership to analyze data, identify issues, reach conclusions, and propose strategies for resolution of complex coding issues.

• Communicate effectively with practice leadership regarding coding and documentation issues by assisting in the preparation of reports and memoranda regarding audit results and coding compliance matters.

• Demonstrates outstanding work ethics and works cooperatively with all team members and management with a can-do spirit and team attitude.

• Assist with audit and entry of charges into EMR system and/or Practice Management System

• Review charges/claims for accurate coding of ICD10, CPT and HCPCS codes.

• Ability to effectively abstract code surgical procedures and assign appropriate place of service and determine medical decision-making levels for E/M services.

• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Required or Preferred Qualifications:

• Must have a CPC, CCS-P, or other professional coding certification

• Minimum of 4 years coding experience required

• 2 years’ experience performing chart audits or assignment of appropriate CPT and ICD10 codes through documentation review, in a physician practice/hospital environment required.

• 2 years’ experience coding Medical Oncology/Radiation/Surgery coding and E/M leveling required

Essential Competencies:

• Attendance is an essential job function

• Knowledge of government, legal and regulatory provisions related to collection activities.

• Knowledge of government programs, i.e., Medicare and Medicaid.

• Knowledge of insurance company’s policies and procedures.

• Knowledge of CPT, ICD-9, HCPCS coding.

• Knowledge of anatomy and medical terminology.

• Ability to prioritize work and manage time efficiently.

• Creative thinking skills, hands-on problem-solving skills and ability to analyze and respond to data.

• Effective communication skills at all levels within organization and excellent customer service skills.

• Ability to train and support new coders by clearly explaining coding guidelines, department workflows, system processes, and documentation expectations.

• Proficiency in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook, Payer sites), database and patient scheduling and other medical information systems.

• Attendance is an essential job function.

This job description does not contain a full listing of activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.