Medical Coding Specialist Job Description
Medical coding specialist
provides medical review and approval of all promotional materials in compliance with Codes of Practice, Genentech SOPs, and US regulations.
Medical Coding Specialist Duties & Responsibilities
To write an effective medical coding specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included medical coding specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Assigning an appropriate DRG (Diagnosis Related Group) to each coded inpatient account to obtain optimal hospital reimbursement
Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA) and the Center for Medicare & Medicaid Services (CMS) with regards to the assignment of ICD-10, CPT, and HCPCS codes, including knowledge of the 95/97 Evaluation & Management billing guidelines
Enter and code patient services into a computer system
Generate invoices to be sent to patients
Sort and file paperwork
Handle insurance claims
Perform collections duties
Conduct evaluations onsite at provider locations to ensure effectiveness of programs and make/recommend modifications as necessary
Educate Providers on coding using a wide variety of methods and media to deliver technical content
Set clear expectations on appropriate coding based on CMS and HCC cateogries
Medical Coding Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Medical Coding Specialist
List any licenses or certifications required by the position: CCS, CIC, RHIT, CANPC, AHIMA, AAPC, CRC, CPC, ICD, BCHH-C
Education for Medical Coding Specialist
Typically a job would require a certain level of education.
Employers hiring for the medical coding specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Medical, Education, Health Information Management, Associates, Healthcare, Sciences, Graduate School, Faculty, Patient Care, Medicine
Skills for Medical Coding Specialist
Desired skills for medical coding specialist include:
Medical terminology
Physiology
HCPCS codes
APCs
Anatomy
CPT codes
DRG
Itemization of charges
Medical Fees in the US
Medical necessity criteria and applicable industry standards
Desired experience for medical coding specialist includes:
Support the provider's success by providing necessary resources and materials
Identifying diagnoses, complications, comorbidities, and procedures for episodes of Inpatient care
Assigning appropriate ICD-CM (current edition) and ICD-PCS codes adhering to Official Coding Guidelines
Process an average of 30 to 40 claims per day
Verify CPT, ICD-10 and HCPCS level II codes based on operative reports
Verify insurances
Medical Coding Specialist Examples
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Medical Coding Specialist Job Description
Job Description Example
Our company is looking for a medical coding specialist. 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 specialist
- Following CMS risk adjustment guidelines and develoing a complete understanding of these guidelines
- Understanding the impact of ICD-9 codes on the CMS HCC risk adjustment model
- Defending coding decisions to both internal and external audits
- Improve the accuracy, integrity and quality of the patient data and ensure minimal variation in coding practices
- Perform ICD-9-CM and CPT diagnostic and procedural coding by utilizing a computerized coding methodology and currently accepted coding and abstracting guidelines for billing and data collection
- Code all diagnoses, treatments and procedures according to appropriate classification system
- Analyze inpatient, short stay, and outpatient procedure charts for missing documentation
- Respond to coding questions/issues and reimbursement questions from medical staff and other departments as necessary
- Assigns appropriate concurrent CPT or ICD codes for ancillary services provided in outpatient or clinic visits any specialized services provided in outpatient or inpatient settings
- Review outpatient records and interpret documentation to identify all diagnoses and procedures
Qualifications for medical coding specialist
- Maintain the Outpatient Discharged Not Final Billed (DNFB) report on a regular basis
- Maintain an up-to-date knowledge and understanding of current trends and widely accepted practices related to Health Information Management
- Maintain regular contact and clear communication with the physicians
- Follow the Official ICD-9 guidelines for Coding and Reporting
- Follow CMS risk adjustment guidelines
- Understand the impact of ICD-9 codes on the CMS HCC risk adjustment model
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Medical Coding Specialist Job Description
Job Description Example
Our innovative and growing company is hiring for a medical coding specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for medical coding specialist
- Reviews, analyzes, and interprets physician documentation with regards to procedure and diagnosis code selection
- Identifies discrepancies between the physician code selection and the medical record documentation
- Performs scheduled audits of physician coding and documentation to make recommendations for improvements and enhancements
- Maintains a close working relationship with assigned physicians and medical office, frequently querying the physician when coding discrepancies arise
- Researches any coding questions the physician or medical staff may have, and presents findings to them
- Codes hospital cases by reviewing the procedure reports, other documentation, and the assignment of diagnosis and procedure codes, releasing charges within the Epic system
- Demonstrates a high skill level in correlating generalized observations/symptoms to a stated diagnosis to assign the correct ICD-10 code
- Has a thorough understanding of the differences between professional coding in a clinic setting as compared to professional coding in a hospital setting (outpatient and inpatient), and demonstrates a high skill level in the practical application of that knowledge
- Reviews Advanced Beneficiary Notices (ABNs) and confirms that the form is valid with regards to the information entered on it
- Reviews encounter forms, identifies any issues with the forms, and corrects them before posting charges
Qualifications for medical coding specialist
- Ability to code any category of outpatient record across a multi-facility system
- Must be able to manage high volumes of work within strict deadlines
- CPC Certificatoin Required
- Billing/Coding School Certificate/Diploma or relevant experience is required
- Must be proficient with Microsoft Office Suite including Word, Excel, and Outlook
- Bachelor’s Degree in Business Administration or Associates or Bachelor's degree in Health Information Management preferred
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Medical Coding Specialist Job Description
Job Description Example
Our innovative and growing company is looking for a medical coding specialist. 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 specialist
- Maintains an in-depth knowledge of Epic ambulatory and hospital modules
- Stays current regarding knowledge of updated regulations, laws, and new procedures
- Assists with all coding functions at or above the level of a Medical Coding I job summary
- Attends all mandatory in-services and department meetings
- Maintains a professional appearance and encourages behavior appropriate for a healthcare setting
- Consistently demonstrates a self-directed, mature, disciplined and tactful approach to completing work duties
- Provides spontaneous and accurate responses
- On occasion, with the coordination of the supervisor adjusts workload
- Understands and applies the Team Concept
- Performs ongoing prospective coding and documentation chart reviews for physician services to ensure that the coding supports the services billed
Qualifications for medical coding specialist
- Licensure /Certification in coding (CPC, CCS-P, RHIA, RHIT) required
- Minimum of 1-3 years professional coding experience required
- Demonstrated knowledge of 1995 and 1997 Evaluation and Management Documentation Guidelines and other professional documentation requirements
- Minimal degree of travel
- Certified in professional coding (currently holds either CPC, CPC-H, CCA, or CCS-P credential)
- Prefer two years of experience coding professional charges in an outpatient or clinic setting
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Medical Coding Specialist Job Description
Job Description Example
Our growing company is hiring for a medical coding specialist. 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 specialist
- Stays abreast with compliance on federal, state health care laws, regulations and rules
- Work with appropriate medical staff and other coders when performing coding functions
- Performs standard clinic coding and some charge entry
- Work with Business Office staff in developing efficient coding processes by reviewing incoming EOB's or denials
- Maintain a working knowledge of common coding and documentation practices and requirements to the physician clinic practices
- Corrects any problems with encounter forms before charges are submitted
- Respond to customer concerns through coding reviews requested by other departments
- Liaison to the clinics for coding issues and concerns
- Research and process missing physician charges
- Keep updated on applicable regulations, laws and procedures
Qualifications for medical coding specialist
- Ability to use a personal computer for input, evaluation and optimization of diagnostic/procedural information
- Calculator and computer skills
- Knowledge of all business office software a plus
- May be required to work weekends, holidays and reasonable amounts over overtime when necessary
- Ability to perform duties in a highly organized, efficient and reliable manner
- Must be able to work independently and use sound judgment to execute assignments
5
Medical Coding Specialist Job Description
Job Description Example
Our company is looking for a medical coding specialist. 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 specialist
- Following CMS risk adjustment guidelines
- Develops professional expertise, applies company policies and procedures to resolve variety of issues
- Works on problems of moderate and complex scope where analysis of situations or data requires a review of variety of factors
- Coordinates the development and implementation of curriculums for current and newly hired physicians/healthcare providers
- Coordinates the development and implementation of shared webinars and live presentations on topics relating to coding and documentation
- Provides individual and group education to providers, clinic staff, billing staff and others who require coding and documentation knowledge
- Performs coding and documentation assessments to determine any issues relating to coding, documentation, or missed revenue opportunities and delivers individualized training based on these findings
- Provides shadowing services to physicians/healthcare providers to supply feedback on documentation and coding to ensure appropriate reimbursement, while conforming to applicable guidelines and regulations
- Collaborates with the EMR team to develop and implement strategies to make appropriate documentation and coding easier for providers
- Utilizes knowledge and experience pertaining to documentation, coding and billing of services to federal health care programs to address functional goals
Qualifications for medical coding specialist
- Two years of progressive on-the-job hospital outpatient coding experience
- A minimum of 10 years of medical coding and/or auditing experience in two or more medical, surgical, and ancillary specialties within the past 15 years, including at least 5 years of experience in a training role (training auditors, coders, and/or providers), or a minimum of 3 years’ training experience within the last 6 years in a military coding environment
- A minimum of 1 year of performance in the specialty is required to be qualifying
- Multiple specialties encompass different medical specialties
- Coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience
- Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor