Coding And Reimbursement Specialist

Overview

• Provide expert technical guidance on urology coding and reimbursement projects, ensuring accuracy and compliance with industry standards.
• Assist in addressing coding inquiries, conducting research, and preparing detailed summaries for internal and external stakeholders.
• Support CPT and RUC-related activities, including code change applications, survey material preparation, and follow-up tasks.
• Analyze and interpret large data sets to inform coding strategies and provide actionable recommendations.
• Offer strategic advice on insurance coverage, payment policies, and payer guidelines to enhance reimbursement outcomes.
• Maintain and update consulting program trackers and manage correspondence related to payment policy inquiries.
• Provide practice management support for coding, billing, and claims inquiries during meetings or upon request.
• Ensure seamless execution of recurring coding and reimbursement activities during high-demand periods.

Key Responsibilities & Duties

• Respond to coding and reimbursement inquiries from members and stakeholders with accurate and timely information.
• Monitor and analyze trends in coding issues to identify opportunities for improvement and advocacy.
• Prepare and review materials for CPT and RUC processes, including surveys and formal recommendations.
• Analyze complex data sets to support coding strategies and decision-making processes.
• Provide expert guidance on urology-related codes, payer policies, and reimbursement strategies.
• Coordinate follow-up actions for consulting program trackers and manage payment policy inbox communications.
• Assist in administrative tasks related to coding activities and meeting preparations.
• Ensure confidentiality and compliance with organizational policies in all activities.

Job Requirements

• Bachelor of Arts degree required, with strong knowledge in medical coding and reimbursement.
• Minimum of 3 years of experience in medical coding; 10 years preferred.
• CPC certification required; expertise in urology coding highly desirable.
• Familiarity with AMA RUC and CPT processes essential for success in this role.
• Proficiency in Microsoft Office suite, particularly Excel, and adaptability to new technologies.
• Proven ability to analyze large data sets and deliver actionable insights.
• Strong organizational skills with attention to detail and ability to maintain confidentiality.
• Experience with specialty societies, payer policies, and MAC LCDs preferred.