Responsible for the collection and coding of simple and complex physician encounters. Processes accurate coding and charge information by patient, including but not limited to ambulatory, hospital-based and surgery center procedures to ensure that claims are submitted to insurance payers in the most compliant, efficient and expeditious manner possible.

Assigns codes using International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).

Sequences diagnoses and procedure codes as outlined in CPT, ICD and HCPC Coding Guidelines while adhering to local and national governmental payer guidelines.

Adheres to the organization and departmental guidelines, policies and protocols. Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.

Reviews all provider documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.

Follows up and obtains clarification of inaccurate documentation as appropriate.

Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and the American Academy of Professional Coders. Adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes.

Meets and exceeds departmental quality and production standards.

Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations.

Participates in payer audits by acting as a resource for coding-related audits, as requested.

Responsible for processing coding claim appeals and coding claim rejections, when applicable.

Licenses & Certifications

Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), orCoding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), orCoding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), orHealth Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), orHealth Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), orSpecialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC).

Degrees

Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Required Functional Experience

Typically requires 2 years of experience in professional coding that includes experiences in physician revenue cycle processes and health information workflows.

Knowledge, Skills & Abilities

Advanced knowledge of ICD, CPT and HCPCS coding guidelines.Advanced knowledge of medical terminology, anatomy and physiology.Intermediate computer skills including the use of Microsoft Office and e-mail as well as exposure or experience with electronic coding systems or applications.Excellent oral and written communication and interpersonal skills.Excellent organization, prioritization and reading comprehension skills.Excellent analytical skills, with a high attention to detail. Demonstrates ability to function as a mentor, role model and teacher. Ability to work independently and exercise independent judgment and decision making. Ability to meet deadlines while working in a fast-paced environment. Ability to take initiative and work collaboratively with others.

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