Job Description

The Pathology Department is seeking a Coding Specialist who will be responsible for diagnosis and CPT coding within the various department billing offices. Will review or code charges for diagnosis and CPT for entry into the JHM and JHU/ PBS billing applications. This can be accomplished through an interface or manual charge entry for services performed at JHM practice sites.



Specific Duties & Responsibilities



Procedural Knowledge

Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Bundle appropriately based on CPT code rule and payer billing guidelines.
Resolves POS vs. CPT code discrepancies.
Verify E/M code type such as New vs. Established patients and level of service.
Responsible for maintaining a system of billing accuracy through encounter verification i.e., clinic schedules, encounter information in EPIC, I/P consults and medical records.
Follows payer guidelines.
Follows limiting coverage guidelines for diagnosis coding by using LCD/NCD/payer policy information and assigns appropriate modifiers based on departmental policy.
Carries diagnosis code out to the highest level of specificity that is appropriate.
Follows ICD-10 codes to ensure diagnosis codes are appropriate for each specialty.
Review and resolve EPIC Charge Review edits daily.
Will research and respond to coding questions from physicians, patients (via SBO Account WQ) and co-workers as necessary.
Exercises independent judgment in daily activities.


Technical Knowledge

Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of JHU/ PBS Billing Applications.
Utilize online resources to facilitate efficient claims processing.


Professional & Personal Development

Participate in on-going educational activities.
Assist in the training of staff.
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 (mostly seated) up to 80% of the time.
Occasionally required to traverse throughout the work area or to retrieve supplies or mail/documents from other locations.
The employee is required to operate computer keyboard, mouse, calculator, and phone 80% of the day; additional duties may require opening envelopes, removing or applying staples, processing mail; requiring finger dexterity and some repetitive motions.
Prolonged vision requirements including ability to see/viewing computer screen, paper reports/documents, charts.
Position requires frequent use of the telephone, while multi-tasking to retrieve or review information from the computer in order to assist callers quickly and confidentially.
Must be able to communicate using the spoken and written word in a clear, concise, and professional manner. Able to hear within normal range.
May transport materials usually less than 20 pounds from one area to another; may be required to lift and/or move up to 40 pounds with proper training, or precautions/lifting aides (example: file boxes, copier paper, mail bags).
In some areas workspace is confined; may work in an open workstation or cubicle.
Staff may be required to complete annual competency review, and must ensure compliance with Hospital Policy, Laboratory Policy & Procedure, Health, Safety & Environment regulations, and all applicable privacy & confidentiality laws/practices.
Johns Hopkins School of Medicine – Clinical Operations - Required Attendance position: in the event of unexpected university closings including inclement weather or declared emergency, the employee in this position may be required to report to work and/or remain at work and may be required to work additional hours.


Minimum Qualifications
High School Diploma/GED. Medical Terminology, Anatomy, and Physiology courses or demonstrated appropriate knowledge. CPC Certification (or department approved certification).
One-year related experience in medical billing and demonstrated analytical skills. Epic experience. Understanding of third party payer issues.
Additional education may substitute for experience to the extent permitted by the JHU equivalency formula.


Preferred Qualifications
Epic experience.
Understanding of third-party payer issues.