Position Summary:
The Coding Specialist position translates medical documentation into standardized codes for billing, claim processing, and data analysis. This position is a senior level, mentoring position for other coders and requires individuals with significant experience and a high level of coding proficiency. This position requires the ability to analyze operative reports and assign surgical codes according to coding guidelines and payer requirements.
Key Responsibilities:
- Documentation Review: Analyze and interpret clinical documentation to ensure completeness and accuracy for coding purposes.
- Assign Codes: Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services based on clinical documentation and official coding guidelines.
- Validate Codes: Verify and correct codes recommend by Computer-Assisted Coding (CAC) software.
- Utilize Coding Guidelines: Research and utilize all current coding guidelines for appropriate code assignment; including but not limited to AHA Coding Clinic, CPT Assistant, federal regulations, CCI coding initiatives, Official Guidelines for ICD-10 and CPT, insurance payer guidelines and Trinity Health internal coding guidelines.
- Collaboration: Work with healthcare providers/team to clarify inadequate, ambiguous, or unclear documentation to resolve coding discrepancies.
- Workflow and Processes: Follow established workflows and processes to ensure efficiency and productivity.
- Coding Claim Edits: Review, resolve, and process coding claim edits to ensure clean claim submission.
- Productivity: Maintain acceptable productivity rate according to established coding benchmarks based on type of work.
- Quality: Maintain acceptable quality rate at 95% or higher.
- Confidentiality: Ensure strict confidentiality of healthcare and financial records by following Trinity Health policies related to Compliance, Privacy and Security.
- Teamwork: Engage as a team player and assist others as needed.