CODING SPECIALIST

Position Summary: 
Under the immediate supervision of the Health Information Management Supervisor, the Coding Specialist accomplishes Revenue Cycle related responsibilities; and is responsible for the accurate and efficient coding of patient medical records for billing, collection, and reconciliation of accounts. The position is also responsible for educating related departments to ensure that clean and accurate charts are sent to the Health Information Management Department. 

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:
•    Review all medical documentation related to a patient’s provider encounter of hospital services (inpatient and outpatient). Enter all relevant data into the coding software to determine the appropriate ICD-10CM, CPT-4, HCPCS and Inpatient procedure codes to assign to the encounter or hospital service resulting in a complete and accurate claim being submitted to prayer for unsure patients. Coding of the accounting accomplished prior to the end of the “bill hold period”, as established by the Health Information Management Supervisor where all required documentation is in the medical records. 
•    Determine if required documentation to properly code an encounter is missing. Work with Health Information Management (HIM) to follow up with the provider to obtain the missing documentation.
•    Print lists of clinic and outpatient hospital encounters, lab and x-ray reports as well as inpatient admissions to organize work and ensure that all clinic and hospital services are properly coded. 
•    Print any/all necessary reports, including lab reports and radiology reports if they are not in the patient record. If additional clarification is needed/required query the attending physician.
•    Verify accuracy of documentation with providers and nursing staff, especially in the event there is a discrepancy within prescribed timeframes.
•    Clarify information or diagnosis by communication with healthcare providers. 
•    Enter coding information into the Meditech Expanse system or other utilized billing software systems and ensure data is transferred to access of Account Representative for billing.
•    Report any discrepancies to the Health Information Management Supervisor, providing all supporting documents and recommending resolution. 
•    Perform other duties as assigned.
 

    Minimum Qualifications: 
•    High School Diploma or General Equivalency Diploma.
•    Two (2) years of post-High School education in Business/Accounting, or an Associate degree in Health Information Management from an accredited college or university is preferred. 
•    Two (2) years of experience in medical coding within a clinic or outpatient hospital setting. Medical coding within an inpatient hospital setting, preferred. 
•    Must obtain a valid certification with American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) within 1 year of hire. 
•    Must successfully pass the Employee Health Screening requirements and background investigation.
    
    Knowledge, Abilities, Skills, and Certifications: 
•    Knowledge of Medical Terminology, Medical Decision Making, the coding process, and other coding initiatives related to such. 
•    Knowledge of ICD-10CM, CPT-4, HCPCS and Inpatient Procedure coding and its impact on insurance claims, billing and collections.
•    Ability to organize and keep records/files up to date. 
•    Understanding of Third-Party reimbursement/claims processing and follow up processes
•    Knowledge of hospital and/or physician patients accounting systems required: knowledge of the Meditech Expanse system preferred. Familiarity with Microsoft Office applications such as Word and Excel. 
•    Familiar with the Joint Commission accreditation, HIPAA, Federal, State, and local regulations related to coding and insurance billing. 
•    Ability to develop mutually beneficial relationships with both internal and external customers.
•    Ability to model Sage Memorial Hospital mission, values and ethical standards and to perform work responsibilities in an effective, timely and efficient manner. 
•    Ability to understand and promote departmental and organizational goals and to effectively prioritize and perform work responsibilities in a manner which best achieves those goals. 
•    Ability to take responsibility for and ownership of the outcomes of all individual actions and decisions in fulfilling work responsibilities with emphasis on customer satisfaction, quality, safety, productivity and attendance. 
•    Follow organizational policies regarding work product, work performance and conduct.
•    Ability to perform tasks without constant supervision, the delivery of assigned work on a timely basis, and follow-up of all assignments, on a timely basis.
•    Ability to speak the Navajo language and/or familiarity with the Navajo Way.

    Physical Demands: 
This position may entail sitting for extended durations of time to complete job duties and tasks. Typing and utilization of a computer and/or other typing device for prolonged periods is involved. Any necessary accommodations will be made and implemented appropriately. 
    
    Work Environment: 
Work is generally performed in an office setting with moderate noise level.  Established work hours are generally Monday through Friday, 8:00 a.m. to 5:00 p.m., subject to adjustment related to work requirements.