Responsibilities of the Certified Coding Specialist include reviewing medical documentation provided by physicians and other health providers in order to obtain detailed information regarding disease, injuries, surgical operations, and other procedures to translate into numeric medical codes. In general, the Certified Coding Specialist assigns and sequences diagnostic and procedural codes in accordance with universally recognized coding systems. This position codes all types of records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association (AHIMA) Coding Ethics, as well as all American Hospital Association (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications and other payer guidelines.
Principal Job Responsibilities
- Assigns and ensures correct code selection for compliance with federal and insurance regulations based on clinician documentation
- Follows official coding guidelines and departmental policies and procedures
- Enters and retrieves patient medical data; audits medical record for accuracy and notes deficiencies
- Consults with and educates physicians and other healthcare providers on coding practices to provide detailed information and gather additional documentation
- Collaborates with Clinical Documentation Specialists and members of the medical staff to ensure completeness of documentation in charts so appropriate codes are assigned.
- Verifies charges and documents reasons accounts not coded
- When applicable, apply the appropriate charges for evaluation and management services, injections, infusions and other procedures.
- Monitors and works accounts that are Discharged Not Final Billed to ensure timely, compliant processing of accounts through billing system.
- Provides coding support to revenue cycle teams in correcting charge/code related claim edits to meet payer filing requirements
- Meets accuracy, quality, productivity and key performance metric indicators
- Maintain current knowledge of ICD-10-CM/PCS and CPT/HCPCS coding systems and retains current coding certification
- Facilitates validations of coding-related software by testing and troubleshooting applications that impact coding workflows
- Provide expert knowledge of health care and industry trends to Trilogy team in coding areas
- Function as internal consultant to Trilogy staff and organization leadership on coding related issues and questions
- Assists with review and resolution of coding-related denials
- Associate’s degree in health informatics or information management from a program accredited by the Commission on Accreditation for Health Informatics and Information Management preferred.
- Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or coding related certification through AAPC or AHIMA required
- Minimum 2 years medical coding experience
- Knowledge of CPT, HCPCS and ICD-10 Coding conventions
- Good working knowledge of coding regulatory and compliance guidelines
- Skilled in teamwork dynamics
- Excellent communication and presentation skills in both written and verbal formats, including the ability to produce clear and well-organized documentation
- Customer-focused, team player with a desire to continuously improve current business practices/processes
- Passionate about excellence, coding quality and integrity; with the ability to drive process improvement of coding-related issues
- ICD-10 – 2 years
- CPT Coding – 2 years
- Medical Coding – 2 years