The Coding Specialist II will review outpatient hospital medical records to assign accurate ICD-10-CM, CPT, and HCPCS codes, ensuring compliance with official coding guidelines and ethical standards. This role involves validating documentation, issuing provider queries when necessary, abstracting required data for reporting, and participating in coding quality reviews.

This role provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Performs on...

The specialist will support value-based care initiatives by reviewing patient records, conducting outreach, gathering necessary health information, and assisting care teams with accurate documentation. Key duties include reaching out to patients with care gaps to schedule appointments and educating families on prevention and follow-up care.

The specialist will process benefit verification or authorization for all new referrals with speed and accuracy, supporting patients referred to Company to receive specialty medications. This role involves working directly with payers to understand benefit design, interpret medical policies, obtain required authorizations, and communicate coverage details to Patient Access staff.