The Pathology Department is seeking a Coding Specialist III to be responsible for understanding all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Responsible for developing coding and billing change procedures. Responsible for training on all coding and billing changes.

Specific Duties and Responsibilities

Procedural Knowledge

• Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
• Works closely with Office of Billing Quality Assurance to include review of documentation.
• Serves as departmental expert on coding questions.
• Exercises independent judgment and decision making on a regular basis with respect to code selection.
• Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies.
• Research and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
• Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
• Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
• Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
• Review and resolve Epic Charge Review edits daily.
• May act as a backup to Charge Entry when needed.
• Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.
• Works with Department Management to create Charge Review Rules to prevent unnecessary denials.
  

• Works with Department Management on maintenance of provider preference lists.
  

• Provides training on all coding changes to providers and staff. Develops presentations to effectively communicate how changes will affect provider billing and coding. Provide face to face training on changes to providers based at all Hopkins locations.

Technical Knowledge

• Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Working knowledge of JHU/ Epic Billing Applications.
• Utilize online resources to facilitate efficient claims processing.
• Capable of advance problem solving in medical billing and coding.

Professional & Personal Development

• Participate in on-going educational activities.
• Keep current of industry changes by reading assigned material on work related topics.
• Complete three days of training annually.

Service Excellence

Must adhere to Service Excellence Standards.

• Customer Relations
• Self-Management
• Teamwork
• Communications
• Ownership/Accountability
• Continuous Performance Improvement

Specific Physical Requirements

• While performing the duties of this job, the employee may remain in a stationary position (sitting) up to 60% of the time and standing/walking at 40%. Occasionally required to traverse throughout the laboratory or to retrieve equipment, supplies, or specimens from other locations on campus. The employee is required to operate computer keyboard, laboratory instruments, and small laboratory tools such as pipettes, cutting instruments, glass tubes, dishes, and/or slides. Constantly repositions self to perform duties at laboratory workstations, gathering specimens, and loading equipment.
• The employee is required to use hands/fingers to touch, type and/or feel. Will operate computer keyboard, and/or laboratory instruments, small laboratory tools such as pipettes, cutting instruments, glass tubes, dishes, and/or slides.
• Prolonged vision requirements including viewing computer screen, paper reports/documents charts and results. Visual acuity is required to distinguish fine gradation of color or structure and closely examine specimens (including via a microscope) for laboratory positions.
• May transport equipment and supplies usually less than 40 pounds from one area to another including laboratory supplies or luggage. May be required to lift and/or move up to 50 pounds with proper training, or precautions/lifting aides. In some areas, workspace is limited.
• While most of our positions require on-site presence; where positions are approved for alternate work locations (remote work) – specific expectations will be outlined and documented; and the safety of work environment, security of work information, and productivity measures are regularly reviewed with employees and subject to on-going approval by management. Staff should be aware of and report other remote work implications and requirements that may impact them or the organization.
• Staff may be required to complete annual competency review, and must ensure compliance with Johns Hopkins Policy, Laboratory Policy & Procedure, Health, Safety & Environment regulations, and all applicable privacy & confidentiality laws/practices. Annual training and testing requirements.

• High School Diploma or GED.
• Five years coding experience with demonstrated analytical skills.

• Medical Terminology, Anatomy and Physiology courses or demonstrated appropriate knowledge.
  

• CPC Certification (or department approved certification).
  

• Experience with Medicare regulations.

• Epic experience.
• Understanding of third-party payer issues.

Classified Title: Coding Specialist III 
Job Posting Title (Working Title): CO Coding Specialist III   
Role/Level/Range: ATO 40/E/03/OG  
Starting Salary Range: $24.25 - $42.50 HRLY ($67,488 targeted; Commensurate with experience) 
Employee group: Full Time 
Schedule: Monday-Friday, 8:30am-5:00pm 
Exempt Status: Non-Exempt 
Location: Remote 
Department name: SOM Pat Production Unit Billing  
Personnel area: School of Medicine