DaVita Coding Specialist I in Commerce, California

OVERVIEW OF POSITION:

Responsible for participating in the implementation of the organization’s Coding Proficiency program. Performs medical chart audits for Evaluation and Management and ICD-9 coding and documentation. Interfaces and disseminates audit results to clinicians and management.

ESSENTIAL FUNCTIONS:

  • Performs medical chart audits meeting minimum productivity standards.

  • Educates clinicians on specific coding issues found in senior HMO pre-audits.

  • Submits and follows up on query forms to clinicians based on “inferred” chart audit data.

  • Submits weekly audit totals to Coding management.

  • Performs claims analysis for appropriate CPT and ICD-9 coding.

  • Identifies CPT unbundling in claim submissions.

  • Uses coding knowledge to work the claim system edits.

  • Performs Coding analysis of claims denials.

  • Reviews TES edits for coding analysis.

  • Works with Claims management and IPA / contracted clinicians on claim edit resolution.

  • Stays abreast of industry coding and compliance issues.

  • Participates in coding / auditing discussions to ensure best practice efforts and processes are implemented ensuring maximum reimbursement through appropriate coding.

  • Attends Coding program monthly meetings.

  • Performs additional duties as assigned.

EDUCATION:

  • One or two years of post-high school education or a degree from a two-year college.

  • Coding certification through AAPC or AHIMA required.

EXPERIENCE:

Minimum:

  • Over 1 year and up to 3 years of experience of ICD9, CPT and HCPCS coding experience or successful completion of Coding Program internship.

Preferred:

  • 3 years medical billing or health care experience.

  • IDX BAR experience.

  • Allscripts / Enterprise experience.

  • Clinical experience.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate with medical billing software.

  • Proficient in Word, Excel, PowerPoint, Multi-media projector.

  • Knowledge of CMS coding guidelines.

  • Excellent verbal and written communication skills in the English language.

  • Must be able to work independently to carry out work efforts.

  • Bilingual / Spanish preferred.