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AWHS Certified Medical Coder Specialist Job Description

Job Summary:

The Certified Medical Coding Specialist will review clinical documentation and diagnostic results as appropriate and validate and ensure correct procedural and diagnostic coding of professional services rendered by clinicians evaluate. The Coding Specialist will review medical records and charge tickets to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-9 & ICD-10), and the American Medical Association’s Current Procedural Terminology Manual (CPT). The Specialist will also provide technical guidance and training on medical coding to physicians and staff.

Reports to: Billing Manager.

FLSA Status: Non-Exempt.

Essential Duties/Responsibilities:

• Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports patient care visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9, ICD-10, and CPT codes.
• Reviews Medicare records and charges for completeness and accuracy based on CMS requirements before submission to minimize claim denial.
• Evaluates records and prepares reports and/or trends on such topics as the number of denied claims or documentation or coding issues for review by management.
• Makes recommendations for changes in policies and procedures; maintains knowledge and is familiar with physician billing and accounts receivable. Updates any held procedures manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
• Stays abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
• As needed, educates and advises staff on proper code selection, documentation, procedures, and requirements.
• Maintain working knowledge of the EMR system and any technology needed for the position.
• Meets department production standards consistently as defined by management.
• Other duties as assigned and/or requested by your supervisor or management.

Required Knowledge/Skills/Abilities:

• Knowledge of ICD-9, ICD-10, and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
• Knowledge of reimbursement methodologies associated with each coding system.
• Knowledge of office policies and procedures to accurately answer questions from staff, physicians, and patients.
• Knowledge of administrative and clerical procedures and systems such as word processing, Microsoft Office, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
• Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Knowledge and correct usage of medical terminology.
• Ability to navigate and effectively use EMR. Knowledge and experience with Centricity EMR system is preferred.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to maintain confidentiality and professionalism.
• Ability to effectively and clearly communicate in writing, over the telephone, and in person with physicians, office staff, and patients.
• Ability to work as part of a team and promote a positive work environment.
• Ability to listen and understand information and ideas and adjust actions accordingly.
• Ability to comply with all facility policies, procedures and practices.
• Ability to follow directions/instructions from supervisor.
• Ability to read and interpret medical procedures and terminology.
• Ability to exercise independent judgment.
• Skilled in establishing and maintaining effective working relationships with other employees, patients, and the public.
• Skilled in reviewing health care delivery against established guidelines coupled with knowledge of severity of illnesses/severity of service review criteria.
• Skilled in organization, attention to detail, and task prioritization.
• Skilled in ability to exercise independent judgement and ability to proactively look for ways to help people.
• Skilled in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Skilled in understanding patient needs to provide exceptional customer service.

Education and Experience:

• High school diploma or GED required; Associates degree or higher preferred.
• Current Certified Professional Coder (CPC) certification issued by the American Academy of Professional Coding or Certified Coding Specialist (CCS) certification issued by the American Health Information Management Association is required.
• Two years of previous experience in medical record coding, or the equivalent combination of experience, required education, and training that would provide the required knowledge and abilities.

Physical Requirements:

• Prolonged periods of sitting or standing at a desk and working on a computer in a stationary position. Must be able to remain in a stationary position for a prolonged period of time.
• Constantly operates a computer and other office machinery, such as a calculator, copy machine, computer printer.
• Must be able to lift up to 15 pounds at times and transport up to 15 pounds at a time over short distances.

This job description is subject to change at any time. Management may assign or reassign duties and responsibilities to this job at any time.

I, the employee, acknowledge the receipt of this job description and have been given the opportunity ask questions regarding its content:

Employee Signature: _____________________________ Date: ___________________

Employee Name: ________________________________