Job Summary: The Certified Medical Coding Specialist must possess a current AAPC CPC medical coder certification. The coder must be detail-oriented and exhibit a high degree of accuracy and working knowledge of medical terminology, anatomy, and physiology. The coder must have expert skills in the proper use of the ICD-9/ICD-10, CPT, HCPCS coding manuals, as well as, Medicare’s National Correct Coding Initiatives (NCCI) edits. Major responsibilities include analyzing medical claims before submission to insurance for accuracy of coding, knowledge and skill to resolve insurance denials, and the ability to accurately complete medical record chart audits while adhering to Medicare’s 1995/1997 E/M Documentation Guidelines and individual payer policies.
Reports To: CBO Manager
Position Level: 6E
Essential Functions of the Position:
- To exhibit expert coding skill in the proper use of the ICD-9/ICD-10, HCPCS, and CPT coding manuals, including Medicare’s National Correct Coding Initiative (NCCI) edits.
- Efficiently analyze insurance claims independently before submission; to submit claims with accurate coding at all times and in a timely fashion to ensure optimum reimbursement and compliance.
- Contributes to the achievement of the Coding Department goals and objectives and adheres to departmental policies, procedures, and performance standards.
- Demonstrate proficiency in using Payer and coding websites to stay up-to-date on coding issues, coding changes, or other that affects compliance and reimbursement and shares appropriately with the rest of the coding staff.
- Effectively integrates coding/billing changes through the proper channels; changes in workflow and revenue issues must be forwarded to the attention of the coding manager.
- Demonstrates excellent communication skills both verbally and written when dealing with either business or clinical staff (e.g., patient complaints, provider questions, coding feedback). Effective listening techniques.
- Demonstrates the ability to quickly identify and investigate possible coding compliance issues and trends; performs thorough and complete investigation, and reports any significant findings to the attention of the coding manager in a timely fashion.
- Demonstrate an appropriate overall level of performance according to job grade level; as determined by the coding manager (e.g, coding skill, problem solving, leadership, and needed supervision).
- To complete additional work projects or assignments as given, accurately and in a timely fashion.
- To perform as a team player to help meet the department’s monthly goals, and to provide cross coverage in other coding areas when needed.
- Adheres to all HIPPA privacy and security policies and practices. Reports violations and incidents they observe through the proper channels, and cooperates in investigations as requested by management.
- Regular and reliable attendance.
Physical and Mental Demands:
- Average physical ability; able to sit for long periods
- Above average concentration and high level complexity of decision making
- High level of analytical, critical thinking, and reasoning skills
- High level verbal and written communication skills
- Above average ability to manage multiple tasks simultaneously
- High school graduate or GED equivalent
- Current AAPC, CPC coding certification required.
- Proficiency in anatomy and medical terminology.
- Must be able to interact independently with all providers and clinical/business staff to conduct business activities in a courteous and professional manner.
- Requires proficiency in a Windows based computer environment and skill navigating through a typical Practice management and EHR systems.
- Requires proficiency in using the Internet to access payer websites for policies and rules.
- Experience in specialty coding required.