Professional Coding Quality Assurance Specialist III

Job Title

Job Duties & Responsibilities

Assigns ICD-10-CM, ICD-10-PCS, and/or CPT codes.

Reviews and interprets physician documentation to appropriately assign diagnosis and procedure codes.

Communicates with and provides feedback to the education team and/or providers.

Reviews patient charges to determine necessary coding to complete the account.

Identifies principle and secondary diagnoses and procedure codes from the electronic medical record.

Utilizes the encoder or coding books to generate ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.

Sequences diagnosis and procedures to generate appropriate billing.

Queries physicians to obtain diagnosis if not clearly provided in records.

Utilizes other available resources for assignment of codes as necessary (e.g., Epic, MIQS, Cardio IMS, and coding reference materials).

Assists other coders in resolving coding problems.

Provides ICD-10 and CPT, for physician research projects, and for quality reporting purposes.

Completes abstracts for records as appropriate.

Assists in correction of problem accounts.

Reviews charts for completeness.

Participates in education and maintains certification.

Assists in auditing records.

Maintains concurrent coding for inpatient records.

Skills & Requirements

Required H.S. Diploma or equivalent

Required Licenses/Certifications

CCA - Certified Coding Associate by the American Academy of Professional Coders (AAPC)

CCS - Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA)

CCS-P - Cert-CCS-P Physician Based by the American Health Information Management Association (AHIMA)

CIPC - Certified Inpatient Coder by the American Academy of Professional Coders (AAPC)

COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC)