Coding Specialist

Description

Position Summary:   

The Certified Coding Specialist is responsible for the abstraction or accurate coding of procedures from the medical record to ensure optimal reimbursement while staying compliant with OIG, CMS, the local Medicare Administrative Contractor, all system policies and procedures, and any state and other regulatory agencies. The Certified Coding Specialist must adhere to all CPT guidelines and ICD10 Coding Guidelines. 

Duties and Responsibilities:  

• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.  
• Reviews medical record documentation in the electronic health record and/or on paper. Identifies, enters, and posts CPT and ICD10 codes to the electronic health record. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI), or payer-specific guidelines.  
• Consult with physicians/ providers as needed to clarify any documentation in the record that is inadequate or unclear for coding purposes. Provides education around documentation improvement for maximum patient care. 
• Assists physicians/providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to  
• Reviews and resolves charge sessions that fail charge review edits, claim edits, and follow-up denials. Works to improve billing based on findings/resolution of errors. 
• Work with departments to optimize reimbursement, ensure charge capture, reduce late charges, and provide feedback to providers.  
• Providing guidance on billing/coding discrepancies, questions, and issues to providers and customers.  
• Responsible for maintaining workload balance, ensuring maximum efficiency, eliminating rework, and reducing cost.  
• Review and respond timely to requests, including emails, telephone calls, issues, account research, and resolution as needed by coworkers, management, and clients. 
• Participate in meetings, conference calls, and training sessions, including Management Meetings, Team Meetings, as well as any meetings while working telecommuting during the assigned daily work schedule. 
• May process incoming and outgoing mail  
• May receive incoming telephone calls and resolve issues communicated. 
• Ability to interpret and apply policies and procedures. 
• Performs various duties as needed in order to successfully fulfill the function of the position. This is a safety-sensitive position.   

Qualifications:  

• Education: 
• High school diploma or equivalent. 
• Experience: 
• Minimum 1 year of coding experience and certification required. 
• Licenses/Certifications: 
• Appropriate Coding Credential: CCS for Inpatient and CCS, CCS-P, CPC, or CPC-H for Outpatient. RHIA or RHIT certification (preferred). 
• Skills: 
• Knowledge of CMS rules and regulations (preferred). 
• Knowledge of CPT (including Evaluation and Management). 
• ICD-10 diagnosis and procedural coding, and HCPCS coding. (preferred) ? Interpersonal teamwork skills.  
• Basic Microsoft Excel and Word knowledge. 
• Medical billing knowledge. 
• Analytical skills Organizational skills.