CODING SPECIALIST

Job Description

Job Description

This position is responsible for accurately translating medical diagnoses, procedures and services from physician notes into standardized codes (like ICD-10, CPT) for billing insurance, ensuring compliance, resolving claim denials, communicating with providers for clarification and facilitating timely reimbursement for healthcare services.

QUALIFICATIONS:

• Certified Professional Coder Certification (Required) this is an In-Person position
• Keeps coding certification current and earn yearly CEU’s to stay certified.
• Computer skills required: Electronic Medical Records Software; Spreadsheet Software (Excel); Word Processing Software (Word); Electronic Mail Software (Outlook);
• Other skills required:
  • Proficiency in ICD-9 and ICD-10 coding systems.
  • Previous experience in medical billing or coding is required.
  • Experience in appeals preferred.
  • Familiarity with DRG (Diagnosis Related Group) coding is preferred.
  • Excellent customer service skills both over the phone and by email.
  • Exceptional professionally written communication skills.
  • Strong research and organizational skills.
  • Detail-oriented with the ability to multi-task.
  • Ability to work independently and prioritize tasks effectively.

DUTIES AND RESPONSIBILITIES:

• Review and analyze medical records and patient information to ensure accurate billing.
• Verify patient insurance coverage and process claims for reimbursement.
• Communicate with healthcare providers to resolve any billing discrepancies or issues.
• Maintain up-to-date knowledge of coding guidelines and regulations.
• Collaborate with other members of the billing team to ensure timely and accurate billing.
• Review patient documents for accuracy to include but not limited to office visits, surgical, and non-surgical procedures.
• Ensure proper coding on provider documentation.
• Verify that all codes are current and active.
• Report missing and/or incomplete documentation to provider and/or clinical staff.
• Meet daily coding production expectations.
• Perform accurate charge entries.
• Understand coding and reimbursement regulations and recognize the order in which services are billed to ensure maximum reimbursement by reading various coding and insurance newsletters and websites.
• Monitor, make updates and changes to fee schedule.
• Accurately post services based on global services data by applying NCCI edits, AAOC, NASS and ASSH Global Guidelines for all applicable insurance carriers.
• Serve as a resource regarding insurance resolutions and coding questions.
• Communicate changes and updates in coding requirements from insurance carriers to supervisor.
• Post daily charges and correct posting errors in practice management system.
• Assist with external and / or internal audits as requested.
• Review and make corrections based on the Missing Encounter Report.
• Audit charges provided by hospitals/surgical centers to capture all charges for posting.
• Complete annual education courses as required.
• Follow HIPAA, State and Federal regulations.
• Performs other related duties as assigned by management.

**Please note this is an in-person position not qualified for remote.