Medical Coding Job Description
Medical coding
provides secondary determinations for medical necessity of medical/surgical services for members using InterQual criteria, vendor program guidelines, and Blue Cross Blue Shield medical policies.
Medical Coding Duties & Responsibilities
To write an effective medical coding job description, begin by listing detailed duties, responsibilities and expectations. We have included medical coding job description templates that you can modify and use.
Sample responsibilities for this position include:
Required to complete 12-15 DRG validations per week and provide 12-15 educational letters back to providers
Process recoups, refunds, claim corrections and appeals
Obtain remittance advice
Contract and insurance verification, EOBs, and payment status
Submit billing insurances
Provides consultation, leadership, and expertise in the planning, implementation, and delivery of coding education
Manages on-going quality audit process to established timeline
Provides leadership in prioritizing quality and education services with coding leaders
Assesses the educational needs of coding resources and develops programs or researches educational resources to meet those needs
Develops training plans/materials and coding pathways for both formal training and use by coders in daily work
Medical Coding Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Medical Coding
List any licenses or certifications required by the position: CCS, CIC, CRC, CPC, AHIMA, CCDS, CDIP, RHIA, AAPC, ICD
Education for Medical Coding
Typically a job would require a certain level of education.
Employers hiring for the medical coding job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Education, Medical, Health Information Management, Faculty, Communication, Medical Billing & Coding, Business, Healthcare, Technical, Management
Skills for Medical Coding
Desired skills for medical coding include:
Medical terminology
Physiology
HCPCS codes
Anatomy
APCs
CPT codes
DRG
Itemization of charges
Medical necessity criteria and applicable industry standards
Payer reimbursement policies
Desired experience for medical coding includes:
Helps identify and document coding trends to provide continuous preemptive education for clients and employed resources
Oversees and coordinates the certification program for coding resources
Participates in the hiring process and educational planning for coding resources
2-4 years of experience in Clinical Coding preferably in ICD 10 CM & CPT
Coding knowledge on multi-specialty
Perform inpatient and outpatient coding
Medical Coding Examples
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Medical Coding Job Description
Job Description Example
Our company is looking for a medical coding. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for medical coding
- Performs charge audit/coding review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers
- Drive the document strategies and messages in a collaborative way with relevant project team subject matter experts
- Produce documents in conjunction with external vendors
- Performs charge audits through review of chart notes and assigns correct procedure and diagnosis codes
- Reads operative notes and codes surgeries or procedures with appropriate CPT and ICD 9 codes based upon the written documentation
- Maintains a high level of confidentiality, promotes ethical and professional standards in compliance with CHS Corporate Policies
- Is a member of the Revenue Cycle Management Front End and Back End Enhancements Task Force actively participates in Coding Committees
- Oversee/organize coding functions
- Supervise staff productivity and recommend process improvements
- Establish process flow guidelines
Qualifications for medical coding
- Ability to summarize and interpret complicated data effectively, concisely and persuasively
- Involved in previous submission
- Degree or qualification in life sciences (e.g., MD, DVM, PhD in relevant field, BSN, PharmD, Master’s or Bachelors’ degree in relevant field)
- Create documents pertaining to clinical data to support product development, license application, and post-marketing maintenance, on behalf of and in conjunction with corresponding project teams
- Excellent interpersonal communication skills (written and verbal) to deal effectively in delicate, sensitive and/or complex situations
- Advanced presentation skills to provide training and education to large or small groups
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Medical Coding Job Description
Job Description Example
Our company is growing rapidly and is hiring for a medical coding. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for medical coding
- Oversee the processes to conduct annual audits, identify gaps, repeating issues and communicate results in provider office sites with data analysis from office site and/or medical record reviews to (a) continually improve the care, service to members and patient satisfaction
- Participate in initiatives requiring cross-functional, matrix relationships
- Assess the impact of potential or actual regulatory changes impacting the assigned area
- Review inpatient records and interpret documentation to identify all diagnoses and procedures
- Maintain the inpatient Discharged Not Final Billed (DNFB) report on a regular basis
- Performs retrospective reviews of medical record documentation to determine opportunities for improvement and education with Clinical Documentation Specialists, Coders and/or patient care teams
- Develops and maintains effective relationship with assigned clinical sections
- Works in a consultative capacity in performing audits and providing feedback and education, in accordance with the protocol set by the department and Corporate Integrity
- Performs annual professional services review for each provider in assigned clinical section, including creating and delivering education/feedback based on the review results
- Plans, writes, develops and conducts on-going training regarding professional services and risk adjustment revenue and reimbursement
Qualifications for medical coding
- Minimum 2 - 3 years applicable experience in medical coding or related area and 15 semester hours in the subject matter area are required
- Direct experience with anesthesia, critical care and pain coding preferred
- High school diploma or GED completion is required
- 4+ years of Medical Coding experience (Hospital Environment a plus!)
- 1-2 Coding Supervision experience preferred
- Foster a culture of learning in a non-confrontational manner
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Medical Coding Job Description
Job Description Example
Our company is searching for experienced candidates for the position of medical coding. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical coding
- Responds to inquiries relating to CPT and diagnosis coding
- Oversees medical record documentation to ensure that services provided are accurate
- Involvement, as an advisor / consultant, in organization-wide initiatives helping to interpret documentation and coding guidelines while providing feedback on how to maintain compliance while enacting the initiative
- Perform Level 1 quality assurance audits per corporate policy
- Collaborates with ISD developers and Medical Oncology Systems Specialist, in the analysis of information systems dependencies, in order to assure Oncology functionality in Oncology applications, department work-flow and clinical operations
- Collaborates with central business office to update CDMs by incorporating new charges/services identified by the departments, third party changes, CMS requirements, and coding updates
- Creates an educational manual for all Financial Counselors which outlines process, expectations, systems and protocol to be followed
- Development and maintenance of standardized coding guidance and documentation requirements for Medical Oncology procedural services
- Evaluate new and existing services to ensure accurate coding and ensure compliance to current coding and reimbursement standards, to compliantly optimize revenue
- In collaboration with Department and ISD development workgroups, designs and implements functionalities in Oncology EHRs for patient demographics, clinical information, and charge capture, including validation testing of these systems under the direction of ISD
Qualifications for medical coding
- Excellent verbal communication skills and professional manner, excellent written communication skills and a familiarity with a variety of writing styles
- Demonstrated computer literacy and knowledge of information systems and comparative data bases
- Minimum of a Bachelor's degree in a related field required
- CPC or other national professional coding certification required
- Medical insurance coding experience preferred
- Intermediate proficiency with Microsoft Office Suite of products
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Medical Coding Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of medical coding. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for medical coding
- Responsible for researching payer and governmental regulatory guidance, and updating Oncology Administration on requirements in order to introduce best practices and ensure regulatory compliance
- Determines, coordinates and supervises daily staffing assignments
- Serves as an internal liaison with other departments that have coding concerns/questions
- Notify insurance companies and patients of account charges
- Assure quality and consistency of data by partnering with other operational teams
- Gathering, reviewing and acting upon coding quality data gleaned from within, and outside of the organization
- Staying abreast of industry standards and governmental regulations and creating coding compliance plans to address as necessary
- Demonstrated management skills and ability to work effectively to build relationships with colleagues, customers, and executive management through positive interaction
- Develops educational programs for providers based on audit findings, general education of coding, documentation guidelines, reimbursement rules and regulations
- Creates and presents customized coding training and initial audit/review for new physicians/providers
Qualifications for medical coding
- Good understanding of UAE healthcare insurance requirements and revenue cycle practices
- Formal knowledge of the ICD-9-CM and CPT-4 classification systems with understanding of the effect it has on data quality for prospective payment, utilization, and reimbursement
- Must possess good technical skills and should be comfortable interacting with employees, physicians, and other users of medical record information in a variety of situations
- A Bachelor's degree in Nursing, Pharmacy or other Biological Science is required
- Bachelor's degree in Medical Coding or related field preferred
- Master’s degree in Medical Coding or related field preferred
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Medical Coding Job Description
Job Description Example
Our company is looking to fill the role of medical coding. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical coding
- Assists the Business Services Manager with developing and maintaining department policies and procedures
- Take responsibility to support team members in meeting project milestones and objectives (even when team members or milestones are not their direct responsibility)
- Travels to clinic locations to build relationships and support providers and clinic leadership
- Acts as liaison between contractor management staff and the Government, and will have supervisory authority over the other Medical Coding Compliance Specialist contract personnel performing under this contract
- Works with contractor management staff and the Government in design, execution, and monitoring of training or individual development plans of assigned Medical Coding Compliance Specialist personnel under this contract
- Acts as Trainer assists the AFMS MCPO by researching and developing compliance and compliance training programs, and assists with developing and monitoring the AFMS coding compliance plan
- Leads other Medical Coding Compliance Specialists in conducting assessments to identify new development needs and makes recommendations accordingly
- Audit medical records to ensure compliance with the organization’s coding procedures and standards including, abstraction and assignment of appropriate codes based on clinical data
- Accurately enter coded data into a system and validate data entered
- Research correct coding practices, clearly document and share findings with others
Qualifications for medical coding
- Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred
- CPC, CPC-H, CPC-A or CPC-H-A certified preferred
- Experience as a health information management practitioner
- Bachelor's degree or equivalent plus training and education as a Certified Professional Coder (CPC) or Certified Coding Specialist - Physician based (CCS-P)
- This position also requires 1 year of CPT and diagnosis coding experience in a healthcare provider or a third party payer
- Demonstrated interpersonal, organizational, analytical, and problem-solving skills