Medical Coding Specialist

Purpose of the Position: The Medical Coder is responsible for reviewing provider documentation and assigning accurate diagnosis, procedure, and service codes in accordance with current coding guidelines and regulatory requirements. This position supports timely and accurate claim submission, promotes compliance with payer regulations, and contributes to the financial health of the organization through accurate charge capture, coding practices, and documentation review.

Essential Functions:

- Review provider documentation and medical records to assign accurate ICD-10-CM, CPT, and HCPCS codes in accordance with current coding guidelines and payer requirements. Interprets medical record documentation to identify all diagnoses and procedures. Assesses the accuracy of medical record documentation to ensure that it supports all diagnoses and procedures to which codes are assigned in accordance with current ICD-10-CM & CPT coding guidelines and payer requirements.

- Perform charge review to ensure services rendered are accurately documented, coded, and captured for billing. Applies knowledge of coding, billing and reimbursement rule/regulations to ensure accurate coding and charging.

- Identify coding discrepancies, missing documentation, or charge capture issues and communicate findings to providers and appropriate staff. Queries conflicting, ambiguous or non-specific documentation by consulting the appropriate physician or clinical staff in a professional and tactful manner as coding questions arise.

- Applies NCCI edits, LDC, NDCs and modifiers as appropriate.

- Applies knowledge of current approved ICD and or CPT coding guidelines to assign codes and sequence the diagnoses and procedures correctly. Utilizes SelectCoder when appropriate for accuracy and efficiency.

- Triages any conflicting, ambiguous or non-specific coding concerns to the Coding Team Lead.

- Conduct denial reviews related to coding and documentation, identify trends, and recommend corrective actions to reduce future denials.

- Collaborate with providers and clinical staff to clarify documentation and support accurate code assignment.

- Provide ongoing coding and documentation education to providers and staff to promote compliance, coding accuracy, and optimal reimbursement.

- Participate in internal coding quality audits and compliance reviews; implement corrective actions and process improvements as needed.

- Monitor coding guideline changes, payer updates, and regulatory requirements and apply changes appropriately.

- Assist in developing and maintaining coding policies, procedures, and best practices. Responsible for knowing and applying internal coding policy and procedures.

- Maintain established productivity, accuracy, and quality standards.

- Timely follow-up on unbilled/denial account reports to expediate claims.

- Participate in departmental meetings, training activities, and quality improvement initiatives.

- Maintains all required certifications or registrations required of this position. Enhance coding skills by attending coding workshops/seminars and by reading reference materials; maintains patient and staff confidentiality.

Qualifications

- Certificate/Degree/License Requirements : Certified Professional Coder (CPC), or Certified Coding Associate (CCA) certification required. CPC-A considered with restrictions of training and pairing with and existing Wildwood Family Clinic CPC.

- Experience Requirements : Minimum of two years of medical coding experience preferred. Experience in a physician clinic, family medicine, or ambulatory care setting preferred

- Education Requirements : High school graduate or equivalent. Postsecondary education Medical Coding

- Required Skills and Abilities :

- Excellent communication and interpersonal skills to engage effectively with clients, families, insurance companies and colleagues.

- Ability to maintain confidentiality and adhere to ethical standards in all professional interactions.

- Proficiency in using electronic health records and other clinical documentation software.

- Demonstrated ability to work independently as well as collaboratively within a multidisciplinary team.

- Strong organizational skills

- Commitment to ongoing professional development and staying current with industry best practices.

- Ability to operate computer, word processing and spreadsheet software, printer, telephone, fax and copier.