Coding Specialist

JOB TITLE: Coding Specialist

REPORTS TO: Revenue Cycle Manager

FLSA STATUS: Non-Exempt

JOB SUMMARY:

In-depth knowledge of Procedural Coding, Specialist in identifying appropriate ICD10 coding based on CMS/HCC categories, analyzes medical records and identifies documentation deficiencies, CPT, HCPCS CMS 1500 FORM, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB, Payments.

QUALIFICATIONS/EDUCATION:

• High School Diploma or higher education required
• Minimum 2 years of experience in medical billing and procedural coding
• Bi-lingual English/Spanish preferred; must be able to read, write and speak English.
• Basic computer knowledge; MS Word and MS Excel, internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send e-faxes and email

CERTIFICATIONS/LICENSES:

ABILITIES/SKILLS:

• In depth knowledge of CPT, ICD10 and HCPCS coding.
• Excellent communication, Customer Service and telephone skills.
• Strong organizational skills and ability to multi-task effectively.
• Must be able to work independently with minimal supervision.
• Able to respect and maintain patient confidentiality at all times. Functions with minimal direct supervision.
• Must be dependable and conduct him/herself in a professional manner.
• Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
• Must be able to follow policies and procedures.

SUPERVISORY RESPONSIBILITIES:

N/A

ESSENTIAL DUTIES/ RESPONSIBILITIES:

• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes coding data to maximize reimbursement.
• Process claims daily, check for errors, making sure that correct diagnosis and CPT codes are used.
• Review claims and determine if Auth or Referral is needed, process accordingly.
• Maintain the billing process within a 15 - day timeframe.
• Must be able to process between 80 to 100 claims per day and submit batch to clearinghouse daily.
• Review progress notes and operative reports before submitting claim.
• Review patient information to determine or identify claim denial causes.
• Submit weekly billing report to manager.
• Maintain accurate and detailed chart notes in the system.
• Perform any other duties as assigned.