Coding Specialist

*This is a US based remote role

*This role is a permanent full time position 

SCOPE/GENERAL PURPOSE OF JOB: 

The Coding Specialist is responsible for abstracting all E/M, CPT, HCPCS, ICD-10-CM, modifier, and units from the medical record documentation.  Other responsibilities include accurately entering data into coding/billing software and/or Excel reports.  Performing accurate coding using applicable guidelines and facility protocols and communicating with staff and/or providers as needed.  Provide written feedback of coding results as needed in the form of comments, summary of findings, and recommendations.  Ensure compliance with federal and state laws, regulations and standards related to health information and coding principles.   

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Assign ICD-10 CM and CPT codes with modifiers for services provided in the facility environment (Ancillary, ED, Evaluation and Management, Observations, Outpatient surgeries, and/or Professional fee coding) depending on the specific client assignment.
• Demonstrates thorough understanding and ability to research all aspects of coding, compliance, documentation and reimbursement for assigned clients and specialties.  
• Review the medical record and all applicable documentation to determine the appropriate codes to assign for the services and diagnoses. 
• Ensures diagnosis codes meet local and national medical necessity guidelines. 
• Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all assigned services.
• Maintains and delivers accurate client worksheets and deliverables.  
• Must maintain accurate records of time spent.  
• Monitors clients for potential compliance concerns and communicates concerns with leadership. 
• Demonstrates the technical competency to use the facility encoder as it interfaces with the hospital/physician mainframe  and/ or EMR in remote setting.  
• Demonstrates proficiency with Microsoft Office Applications in using required computer systems with minimal assistance.
• Assist with periodic client updates and provider education/documentation improvement  
• Identifies trends with provider documentation provides proactive documentation improvement suggestions 
• Review and resolve coding edits and denials.  Assists with rebilling accounts when necessary. 
• Maintain a working knowledge of various laws, regulations and industry guidance that impact compliant coding. 
• Must meet all coder productivity and quality goals. 
• Maintain a 95% accuracy rate. 
• Other duties as assigned.  

EDUCATION AND/OR EXPERIENCE: 

• High School Diploma or GED required. 
• Minimum of two (2) years professional fee coding job experience unless otherwise noted by management 
• Associates or bachelor’s in health information preferred, but not required.
• Must be a certified coder through AAPC or AHIMA (CPC, COC, CCS, CCS-P, RHIT, RHIA)
• Knowledge of ICD, CPT, HCPCS, Anatomy, Physiology, Medical Necessity, Modifiers, and Denials. 
• Excellent writing and interpersonal sills 
• Ability to work independently.  

QUALIFICATIONS: 

Knowledge Areas: 

• Organizational policies and procedures.
• Knowledge of coding documentation and reimbursement.  
• Health care administration and business principles. 
• Clinical processes and procedures as they relate to healthcare coding. 
• Health insurance policies and procedures, particularly as they relate to claims processing. 
• Apply knowledge of anatomy, clinical disease process and medical terminology to ensure accurate procedure, supply and diagnosis code assignment. 

Skills:

• Ability to communicate effectively and professionally with coding staff, clinical staff, and administrative staff. 
• Must be highly detailed with outstanding analytical and writing skills and the ability to communicate professionally with clients and employees.  
• Ability to establish and maintain effective professional working relationships with all employees and clients. 
• Requires analytical, organizing, planning and problem-solving abilities 
• Exercises initiative, judgment, discretion and decision-making to achieve business unit objectives.
• Identifies problems and suggests resolution. 
• Must be competent and comfortable with MS Word, Excel & PowerPoint.