Coding Specialist Jobs

About The Position

Requirements

• Associate’s degree in healthcare, business administration, finance, accounting, or a related field, or equivalent experience in lieu of a degree.
• Required coding credential such as RHIA, RHIT, CCS, CPC/COC, AAPC, or another coding credential.
• At least three years of relevant coding and charge-control experience in a hospital and/or physician practice environment, with experience in revenue cycle, billing, coding, and/or patient financial services.
• Demonstrated knowledge of clinical processes, chargemaster maintenance, clinical coding (CPT, ICD-10, revenue codes, and modifiers), charging processes and audits, and clinical billing.
• Working knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing.
• Knowledge of charge capture, reconciliation, error-management operations, and overall revenue-cycle operations.
• Ability to research, analyze, synthesize, and communicate data and recommendations.
• Ability to follow tasks through to completion, understand complex concepts, remember multiple tasks over time, and work on concurrent tasks or projects.
• Ability to use a computer and other assigned technology and communicate verbally in person or by phone, computer, or device.
• Ability to perform manual dexterity, grasping, and handling activities; occasional climbing, kneeling, crouching, or operating foot controls.
• Ability to maintain a safe working environment, use available PPE, and provide assistance in an emergency.
• Physical requirements include occasional lifting up to 30 pounds unassisted, bending, stooping, reaching, pushing, pulling, and standing or walking; some work may involve prolonged walking, standing, stooping, bending, pulling, or pushing.

Nice To Haves

• CDC (Healthcare Compliance Certification) preferred.
• CHRI certification or membership strongly preferred.
• Knowledge of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures, and pre-bill edits including OCE/CCI edits and DNFB.

Responsibilities

• Research, collect, and analyze information; identify opportunities, develop solutions, and lead issues through resolution.
• Collaborate on performance improvement activities related to program efficiency and patient experience.
• Distribute analytical reports.
• Use system applications to analyze information, create reports, and develop educational materials while prioritizing quality, confidentiality, and safety.
• Research and compile information for ad hoc operational projects and initiatives.
• Analyze and synthesize data, prepare detailed summaries and graphical presentations, identify trends, and recommend practical options or solutions.
• Use program and operational data and measurements to demonstrate progress, return on investment, and impacts.
• Ensure accurate CPT/HCPCS documentation for patient billing and educate colleagues and ancillary departments about documentation and appropriate code use.
• Manage charge capture in assigned Revenue Integrity areas.
• Review charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes, to interpret, validate, and extract charges.
• Verify charges are associated with the correct patient, encounter, and date of service and include required modifiers.
• Review documentation, abstract data, and ensure charges and coding align with AMA and Medicare coding guidelines.
• Perform coding functions, including CPT and ICD-10 assignment, documentation review, and claim denial review.
• Work pre-bill edits within key metrics, including OCE/CCI and DNFB.
• Provide at-elbow support to ancillary departments, including ensuring appropriate capture of supply and implant charges, identifying duplicate charges, and communicating documentation or charge deficiencies and errors.
• Perform charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation.
• Provide feedback to Revenue Integrity colleagues about areas of opportunity.
• Code and/or validate charges for complex service lines using advanced surgical or specialty coding proficiency.
• Educate clinical staff about accurate and complete documentation to support revenue optimization and integrity.
• Maintain knowledge of applicable laws, regulations, compliance requirements, codes of conduct, policies, procedures, and guidelines, and follow honest, ethical, professional, and safe work practices.