Major Responsibilities:

• Assigns codes to office-based visits and procedures using the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
• Resolve coding edits to assure accurate and complete claims submission.
• Sequences diagnoses and procedure codes as outlined in CPT, ICD-10-CM, and HCPCS Coding Guidelines while adhering to local and national governmental payer guidelines.
• Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
• Follows up and obtains clarification of inaccurate documentation as appropriate.
• Codes risk adjustable encounters, resolves CRMs, and trends coding denials, as assigned.
• Conducts formal coding and documentation reviews, clinician reviews and quality reviews, as assigned.
• Assists with coding research functions and education activities.
• Conducts clinician spot check reviews for coding educational feedback to include E&M, ICD-10-CM, HCC, HCPCS, and modifiers.
• Creates clinician coding and documentation education based on query trends or ad-hoc requests. 
• Works clinician support transfer queries Charge Review, Claim Edit, and Follow-Up workqueues, as assigned.
• Performs new clinician educational reviews, as assigned. Adheres to the organization and departmental guidelines, policies, and protocols. Abides by Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement. Maintains confidentiality of patient.

Certification Required:

• Certified Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or 
• Certified Coding Specialist – Physician-based (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Registered Health Information Technician (RHIT) certification issued by the American Health Information Management Association (AHIMA), or
• Registered Health Information Administrator (RHIA) certification issued by the American Health Information Management Association (AHIMA), or
• Certified Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), or
• Certified Professional Coder-Apprentice Status (CPC-A) certification issued by the American Academy of Professional Coders (AAPC) This certification is given out to those who pass the CPC exam but have not yet met the on-the-job experience requirement

Education Required: 

• High School Graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED)

Experience Required: 

• No experience is required

Knowledge, Skills, and Abilities Required:

• Must understand the fundamentals of medical coding.
• Knowledge of ICD, CPT, and HCPCS coding guidelines.
• Knowledge of medical terminology, anatomy, and physiology.
• Basic computer skills including the use of Microsoft Office products, electronic mail, including exposure or experience with electronic coding systems or applications.
• Basic communication (oral and written) and interpersonal skills.
• Basic organization, prioritization, and reading comprehension skills. 
• Basic analytical skills, with high attention to detail.
• Ability to work independently and exercise independent judgment and decision-making.
• Ability to meet deadlines while working in a fast-paced environment. 
• Ability to take initiative and work collaboratively with others. 

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.