Coding Specialist - TMG Billing (Days)

The Coding Specialist is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes for professional services across a multi-specialty medical group. This position ensures compliant, complete, and timely coding of all encounters to support proper claim submission, revenue integrity, and clinical documentation accuracy. The specialist will collaborate closely with providers, billing, and revenue cycle teams to resolve coding-related denials and identify process improvement opportunities.

Key Responsibilities

• Assign appropriate ICD-10-CM, CPT, and HCPCS codes in accordance with official coding guidelines , payer policies, and organizational standards.
• Review provider documentation for accuracy and completeness, querying providers when clarification is needed to ensure correct code assignment and compliance with regulatory standards.
• Monitor and analyze claim rejections, denials, and trends to identify root causes and recommend corrective actions.
• Provide feedback and education to providers and staff regarding documentation improvement and coding updates.
• Participate in internal audits and quality assurance reviews to maintain a high level of coding accuracy.
• Collaborate with billing and A/R teams to resolve coding-related issues impacting reimbursement.
• Initiate follow-up communication with clients, payers, and internal departments to ensure timely resolution of coding and billing discrepancies.

Education

• High School Diploma or equivalent required.
• Completion of an accredited medical coding or health information management program preferred.

Experience

• Minimum of one (1) year of professional coding experience in a multi-specialty or physician practice setting required.
• Experience with EPIC EHR.

Licenses & Certifications

• Required: Certified Professional Coder ( CPC , CIC, COC, CCS , or CCS-P ) or equivalent certification.
• Specialty certification (e.g., AAPC specialty credentials) preferred.

Knowledge, Skills & Abilities

• Thorough knowledge of ICD-10-CM , CPT , and HCPCS coding systems and official guidelines.
• Familiarity with insurance payer rules, billing processes, and denial management.
• Strong analytical and problem-solving skills with the ability to interpret data and form actionable recommendations.
• Proficient in Microsoft Office applications (Word, Excel, Outlook).
• Excellent attention to detail, organizational, and time management skills.
• Effective communication and interpersonal abilities; capable of working independently and collaboratively within a team environment.
• Professional demeanor and commitment to maintaining confidentiality and compliance with HIPAA regulations.

Area of Responsibilities
*Generates monthly reports and staff education. Completes statistical gathering and reporting as needed.
*Performs quality assurance reviews of all entries completed by the patient registrars and reports to administration.
*Performs the coding function to assure timely and accurate billing of insurance claims.
*Prepares monthly performance reports that indicate the impact of work done. This will be done thru the analysis of Aging Reports, Accounts Receivable Reports, and other related documentation.
*Works closely with registrars and medical providers in the department to solve problems and make process improvements.
*Analyzes work on hand on a daily basis and determines how to allocate manpower in an effort to prioritize time.
*Assists with special projects and account analysis procedures when needed.
*Assures accuracy of all CPT and ICD-10 coding.
*Completes data entry for charges.
*Conducts chart review to review clinical documentation and evaluate the appropriateness of coding.
*Coordinate the development and the implementation of billing and collection policies and procedures.
*Corrects all data errors and re-files all claims returned or unprocessed.
*Develops and maintains a high level of expertise in Billing and Collection rules and regulations by reading and studying all applicable bulletins, newsletters, etc.
*Explains insurance benefits, filing procedures, and policy requirements to patients and registrars as needed.
*Handles returned checks/certified mail weekly.
*Indicates follow-up telephone calls and enters detailed comments in the billing system.
*Informs providers and staff of changes in insurance requirements that my affect the billing and claims filing processes.
*Maintains certification in physician practice coding.
*Maintains a good relationship with physician practice for the purpose of resolving billing problems.
*Maintains a working knowledge of department and facility policies and procedures. Displays independent reasoning skills for problem resolution as required with the scope of job assignments.
*Maintains strict confidentiality.
*Prepares documentation for physician review.
*Process month end billing.
*Provides comprehensive analysis and follow-up to all account balances.
*Provides high quality customer service functions to include addressing patient inquiries and complaints from all sources in a timely manner. Initiates necessary corrections to patients accounts and attempts to repair any damage done to relationship with patient. This will require interaction with co-workers, physician offices, and insurance carriers. Success indicated when problems are resolved by team members requiring little director intervention.
*Researches and prepares appeals for any denied or unpaid claims.
*Responsible for analyzing credit balance accounts and initiating refund request.
*Reviews adjustments for accuracy.
*Reviews all insurance EOB forms to assure proper adjudication and payment of each claim.

Compliance Statement
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Education
High School Diploma plus 1 year vocational school

Experience
One year of related experience. Requires a working knowledge of standard practices and procedures.

Licenses & Certifications
*CERTIFIED CODING SPECIALIST

Supervision
*Provides on-going education of clinical staff regarding proper documentation and coding. Regularly leads the work of coworkers and checks performance of work for accuracy.

Qualifications
*Ability to analyze data and form recommendations
*Ability to organize, analyze, and prioritize work load.
*Ability to work closely with others and function as a team number.
*Data entry experience preferred. Must utilize multiple practice software systems.
*Detail oriented.
*Exhibits exceptional communication skills.
*Must have coding certification to include CPC, CPC-H, CCS, CCS-P. Specialty certification through American Academy of Professional Coders is acceptable.
*One year previous medical office billing and collection experience required.
*Professional appearance.
*Proficient in various office software such as Office and Excel.
*Working knowledge of ICD-9 and CPT coding required. Coding certification required. Requires experience in physician practice coding.

Definitions
*Responsible for the oversight of the assignment of ICD-9 and CPT coding for claims. Duties will include monitoring the accuracy of insurance claims, identifying opportunities for improvement, and providing staff education. Initiating follow-up telephone calls to clients, business office, and payers. Responsible for maintaining an accurate charge master with accurate CPT coding. Responsible for analyzing A R issues and providing staff education to improve the collection rate for the clinic.

Contact With Others
Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.

Effect Of Error
Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient's welfare or the organization's interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization's position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.

Supervisory Responsibility
Regularly uses assistance of aide or helper or leads the work of one to four co-employees; checks performance of work assigned as to accuracy and time, doing same work, it's more difficult aspects, or other related work

Mental Demands
Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.


Physical Effort
Minor physical effort - Job requires person to stand and/or walk frequently. Lifts, carries, or uses lightweight (1 to 25 lbs.) materials or equipment less than half of the day. Works in reaching or strained position intermittently. Office or laboratory work requires close visual effort less than half of day. Office or Laboratory work with concentration on a monotonous, repetitious procedure or skill most of day, where speed and accuracy are essential.

Working Conditions
Generally pleasant working conditions/normal office environment.


Working Conditions Aspects For Immunizations
*Directly works with Patients less than 12 months of age

Physical Aspects

Continually (at least once per day)
*Visual

Frequently (at least 3 times a week)
*Typing
*Manual Dexterity -- picking, pinching With fingers etc.
*Hearing
*Speaking

Occasionally (at least once a month)
*Bending
*Reaching -- above shoulder
*Reaching -- below shoulder
*Standing
*Walking
*Lifting up To 25 lbs.
*Handling -- seizing, holding, grasping
*Carrying
*Pushing/Pulling -- up To 25 lbs.