Title: Coding Specialist
Summary: This individual will obtain accurate reimbursement for healthcare claims by assigning procedure and diagnosis codes for insurance billing. He/she will also review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.
Essential Duties: Essential job duties for this position include the following items. Other duties must be performed as assigned or required.
- Compile, abstract and maintain patient medical records to document condition and treatment.
- Review records for completeness, accuracy and compliance with regulations.
- Release information to persons and agencies according to regulations.
- Protect the security of medical records to ensure that confidentiality is maintained.
- Identify, compile and code patient data, using ICD-10, HCPCS, and CPT and other standard classification coding systems.
- Communicate with medical billing specialists to ensure treatment codes are accurately received
- Audits all records to ensure proper submission of services prior to billing
- Receives hospital information to properly bill provider services for hospital patients
- Contacts providers to train and update them with correct coding information
- Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies
- Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
- Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
- Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
- Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
- Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
- Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
- Enhance professional growth and development through staff meetings, education programs, conferences, etc.; attends meetings and participates as required.
- Contribute to team effort by fulfilling other duties as needed.
- Stay current with changing technology, including software and industry specific programs
- Work toward continuous quality improvement
- Uphold, support, and promote all company policies and procedures
Qualifications: To perform this job successfully, the individual in this position must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the minimum knowledge, skills and ability required.
- One year certificate from college or technical school; or three to six months related experience and/or training; or equivalent combination of education and experience.
- Associate’s degree (A. A.) preferred
- Experience using ICD-9-CM, CPT, HCPCs or other standard classification coding systems
- Knowledge of billing practices required
- Knowledge of medical records, EHR required
- Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence.
- Ability to speak effectively before groups of customers or employees of organization.
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
- Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
- Ability to deal with problems involving several concrete variables in standardized situations.
Certificates, Licenses, Registrations:
- Certified Professional Coder Medical Coding Certificate
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- Standing – Approximately 1/3 to 2/3 of on-the-job time.
- Walking – Approximately less than 1/3 of on-the-job time.
- Sitting – Approximately greater than 2/3 of on-the-job time.
- Use of hands to finger, handle or feel – Approximately greater than 2/3 of on-the-job time.
- Reaching with hands and arms – Approximately less than 1/3 of on-the-job time.
- Climbing or balancing – Approximately less than 1/3 of on-the-job time.
- Stooping, kneeling, crouching or crawling – Approximately less than 1/3 of on-the-job time.
- Talking or hearing – Approximately greater than 2/3 of on-the-job time.
- Tasting or smelling – Approximately less than 1/3 of on-the-job time.
- Travel- Approximately less than 1/3 of on-the-job time.
- Weight lifted/Force exerted – An average of approximately 30 pounds, less than 1/3 of on-the-job time, non-continuously.
Physical demand requirements listed are primarily applied to sitting and working at computer for long periods of time, ability to lift and move paper supply, client files, etc.
- Vision – must have clear vision near and far, with or without corrective measures
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job.
Environmental – There is little to no exposure to hazardous environmental conditions.
Noise – Moderate to Loud (i.e. typical medical practice noise – patients, computers, printers, phones, fax machines, etc.)
Further details, questions, and information can be sent to firstname.lastname@example.org
Please, email your resume and application to email@example.com, mail it to 5350 Eastern Ave, Davenport IA 52807, or fax it to 563-359-1512.