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Professional Medical Coding Specialist
2 months ago
Position Summary
The role involves the precise identification and coding of medical records, particularly focusing on Medicaid and Medicare, to ensure compliance with federal regulations based on each patient's diagnosis and procedures. The incumbent will be responsible for posting charges and aiding in the education and training of medical professionals regarding the coding process.
Key Responsibilities include, but are not limited to:
- Engaging in continuous performance improvement initiatives to assess adherence to all coding standards.
- Reviewing patient medical records and assigning the correct code(s) utilizing the ICD-10-CM and CPT coding systems.
- Documenting all surgical and relevant diagnostic procedures while ensuring appropriate procedure codes are assigned.
- Requesting necessary information from physicians or clinical staff when documentation is incomplete.
- Accurately compiling and posting charges in accordance with federal and state insurance regulations.
- Updating demographic and insurance details as required.
- Promptly forwarding code updates to system support upon notification of implementation.
- Maintaining up-to-date knowledge of ICD-10 and CPT coding guidelines.
- Collaborating with clinic and administrative staff to ensure correct claim submissions and assisting in the appeal process to secure appropriate reimbursement for services rendered.
- Working alongside physicians and staff to keep specialty information current and participating in the training of medical personnel in coding practices.
- Understanding and adhering to Medicare compliance regulations.
- Participating in Continuous Performance Improvement (CPI) programs and ensuring compliance with relevant state and federal laws and regulations.
Supervisory Role
This position does not entail supervisory responsibilities.
Required Competencies
To excel in this role, candidates should demonstrate the following:
- Technological Proficiency: Ability to adapt to new technologies and utilize them to enhance productivity.
- Customer Service: Effectively manage challenging customer interactions and respond promptly to needs.
- Communication Skills: Clearly express ideas verbally and in writing, while maintaining good listening skills.
- Diversity Awareness: Show respect and sensitivity towards cultural differences.
- Ethical Standards: Uphold integrity and organizational values in all interactions.
- Professional Appearance: Maintain appropriate dress and grooming standards.
- Punctuality: Consistently arrive on time and ensure responsibilities are managed in the event of absence.
- Safety Awareness: Follow safety protocols and report any unsafe conditions.
Qualifications
To be successful in this position, candidates must meet the following qualifications:
- Associate's degree in a relevant medical or business field is required.
- Completion of medical terminology and/or anatomy/physiology, along with ICD-10-CM coding training/workshop is preferred.
- 2-4 years of experience in an outpatient clinic setting or a combination of education and experience is necessary.
Technical Skills
Proficiency in Microsoft Excel and Word is essential. Familiarity with Electronic Medical Records, particularly EPIC, is preferred, with a requirement to become proficient in EPIC within one year of hire.
Certifications
Preferred candidates will hold a CPC (Certified Professional Coder) credential from the AAPC.
Physical Requirements
While performing the duties of this position, the employee is regularly required to sit and use hands for various tasks. Occasional walking, reaching, and talking or hearing is necessary. The ability to lift and/or move up to 25 pounds may be required. Specific vision abilities include close vision, distance vision, and the ability to adjust focus.
Work Environment
The work environment is typically moderate in noise level. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
This job description serves as a guideline for the primary purpose of the role and its key responsibilities. It may not encompass all duties and responsibilities, which may be modified at management's discretion.
