Job Description

This position is responsible for coding and coding review on assigned cases as indicated by the coding manager, additionally responsible for assisting coding staff with complex cases. Creates, and executes internal coding team education as needed. Works to improve that accuracy, integrity and quality of facility and staff coding, to ensure minimal variation in coding practices and improve quality of case documentation within the body of the billing record to support code assignment. Works with Coding manager to insure the accurate, timely, and complete coding of assigned cases by contracted third party coding resources.

Position Requirements

Total Education/Training/Vocational:

Associates degree in healthcare field, or 3-5 years of Physician/Facility coding experience.

Certification required: CPC, CCS-P, RHIT, RHIA

Primary Position Responsibilities:

  1. Day to day support scheduling and verification department
  2. Performs any and all other duties as assigned by management.
  3. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements.
  4. Query providers regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the billing record
  5. Pre-procedure review of clinical documentation against insurance payer coverage guidelines to determine if medical necessity criteria is satisfied
  6. Assists with research, analysis and response to inquiries regarding compliance, coding, and inappropriate coding
  7. Researches, works proactively with charging departments, and resolves billing and/or charging issues
  8. Researches and appeals coding related denials
  9. Resolves National Correct Coding Initiative (NCCI) Edits, Medically Unlikely Edits (MUE), and other coding related claim rejections
  10. Reviews coding/charge issues associated with credit balance accounts
  11. Enters account corrections and detailed comments in EHR to ensure a clear line of communication
  12. Resolves all coding review requests from all RCM departments
  13. As assigned, compiles daily and monthly reports
  14. Acts as a knowledge resource to RCM staff in coding matters.
  15. Provides leadership and training for less experienced staff members.


Skills / Requirements

Skills and Abilities:

  1. Ability to direct and organize others to meet established goals.
  2. Flexibility, willingness to facilitate change and to take on other duties as assigned
  3. Advanced knowledge of CPT and ICD-10 coding
  4. Advanced knowledge of medical terminology
  5. Advanced knowledge of Medicare guidelines and billing requirements
  6. Maintains confidential information.
  7. Ability to set priorities.
  8. Ability to handle multiple tasks in a busy environment and see them through to completion.
  9. Excellent communication skills.
  10. Possess accurate judgment and decision making skills.
  11. Possess strong initiative to get daily work finished and processed.
  12. Ability to set priorities and work independently.