Certified Coding Specialist Job Description

Certified Coding Specialist Job Description

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Certified coding specialist provides feedback to the coding management team and staff regarding ICD-9-CM/CPT-4 or ICD 10 CM/PCS coding and DRG/APC assignment and related clinical documentation.

Certified Coding Specialist Duties & Responsibilities

To write an effective certified coding specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included certified coding specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Codes and abstracts diagnosis and procedure information from patient medical records according to AHA ICD-9-CM/ICD-10-CM/PCS and AMA CPT-4 coding conventions, UHDDS and CMS guidelines and regulations
Registers and analyzes claims in the EMR system, including insurance verification and charge entry
Review and validate inpatient medical records relative to admission order, ICD9-CM diagnosis/procedure codes assignment and sequencing, discharge status codes, and DRG assignment
Determine coding and reimbursement accuracy for clinical services provided
Construct a detailed narrative rationale for each review and validation, inclusive of references
Create and maintain department processes and controls according to Professional Coding Standards, CMS Standards, HIPAA, national payor coding guidelines as they pertain to professional coding and reimbursement
Safeguard medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security
Enhances professional growth and development through in-service meetings, education, programs, conferences
Monitors and informs manager of records that are not completed timely
Codes and abstracts diagnosis and procedure information from patient medical records according to AHA ICD-10-CM/PCS and AMA CPT-4 coding conventions, UHDDS and CMS guidelines and regulations

Certified Coding Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Certified Coding Specialist

List any licenses or certifications required by the position: LIFE, CCS, AHIMA, AAPC, CPC, RHIT, RHIA, HS

Education for Certified Coding Specialist

Typically a job would require a certain level of education.

Employers hiring for the certified coding specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and High School Degree in Health Information Management, Associates, Health, Information Security, Education, Healthcare, Graduate, Medical, Physiology, Anatomy

Skills for Certified Coding Specialist

Desired skills for certified coding specialist include:

Medical terminology
CPT 4
HCPCS and modifiers
ICD-10 -CM
Claims and state specific insurance/laws
Healthcare industry in areas of coding
Revenue cycle
AAPC to validate coding skills
AHA ICD-9-CM/ICD-10-CM/PCS and AMA CPT-4 coding conventions
Clinical documentation improvement program and functions as liaison for RN clinical documentation specialists

Desired experience for certified coding specialist includes:

Updates coding procedures and guidelines
Assign appropriate diagnosis codes using ICD-10CM and procedure codes using CPT and HCPCS
Link proper diagnosis code with appropriate CPT code for billing purposes
Query physician for when additional information is needed to complete accurate coding tasks
Submit statistical data with regards to weekly production
Process clinical professional charges in a timely and accurate manner, reviewing and processing claims edits for accuracy insurance and coding compliance

Certified Coding Specialist Examples

1

Certified Coding Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of certified coding specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for certified coding specialist
  • Also coordinate re-training of staff as needed due to coding changes/updates, results of audits, Communicate effectively with Patient Business Services, physicians and ancillary departments as necessary to submit accurate and timely billing
  • Coordinate continuing education by contacting clinical staff and arranging in-services for the coding staff, keeping current with other education being offered by AHIMA and other professional organizations
  • Advise and instruct coders/providers regarding billing and documentation policies, procedures, and regulations
  • Code all diagnoses and procedures by assigning and verifying the proper ICD and CPT codes
  • Work with department management on coding interface, development, enhancements and changes, implementation of those functions
  • Maintains understanding of ICD-10 and CPT coding classification systems
  • Educates departmental staff and physicians regarding coding and billing changes
  • Attends seminars and reviews publications to remain current on coding and billing issues
  • Researches and reviews new coding guidelines and policies
  • Obtains continuing educations credits in order to retain coding credentials
Qualifications for certified coding specialist
  • Assists Coding Manager in researching and appealing insurance denials
  • Notifies clinical staff of Anesthesia chart deficiencies on a daily basis
  • Reviews flagged charges to determine if deficiencies are complete and that charge can be submitted
  • Assesses the adequacy of the health record documentation to ensure it supports all diagnoses and procedures to which codes are assigned, apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures
  • Denials – works and processes denials on a daily basis
  • Researches and reviews new coding guidelines and policies, LCD and carrier coding policies
2

Certified Coding Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of certified coding specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for certified coding specialist
  • Assess the adequacy of the health record documentation to ensure it supports all diagnoses and procedures to which codes are assigned
  • Works and processes denials on a daily basis
  • Completes account adjustments as needed to correct charge errors
  • Manually enters charges that are not automatically routed in EPIC
  • Provides information for insurance denials and is a coding resources for others staff
  • Provides information for insurance denials and is a coding resource for others staff
  • Works with the Audit and Compliance Specialist to produce and analyze statistical data for residents and faculty, to create training materials for periodic resident/faculty training sessions
  • Stays abreast of any changes to coding protocols as relates to ICD-10 codes, CPT codes and modifiers
  • Identifies and assigns ICD-10-CM diagnostic and procedural codes to all inpatient discharges ensuring correct APR-DRG and SOI assignment for the purpose of reimbursement, research and compliance with federal and state regulations
  • Identifies and assigns ICD –10-CM diagnostic, procedure codes and CPT4 codes to all Same Day Care records for the purpose of reimbursement, research and compliance with federal and state regulations
Qualifications for certified coding specialist
  • Required High School Diploma required
  • Required to be certified by AACP or AHIMA
  • Required successful completion of at least one AHIMA or AAPC certification program with achievement correlating professional credential (RHIT, CCS, CPC, etc) active and in good standing
  • Required ICD-10 proficiency validation
  • Required 1- 3 years hands on production abstracting or auditing medical records for diagnosis/ medical condition coding
  • Required proficiency with MicroSoft applications
3

Certified Coding Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of certified coding specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for certified coding specialist
  • Abstracts statistical data required from discharges using the hospitals computerized abstracting system
  • Maintains Coding quality accuracy rate of 95% set by the HIMD
  • Maintains Productivity rate of 100% set by the HIMD
  • Appropriately queries physicians for clarification of diagnosis or procedure when the documentation is unclear
  • Monitors the Physician Queries work queue on a daily basis or as directed by manager
  • Maintains Epic and HDM with any abstracting and coding corrections and forwards them to the Coding Manager
  • Monitors and reconciles various Epic work queues to facilitate the billing process within the established timeframes
  • Communicates with various departments within the hospital (admitting, patient financial services, ) regarding billing and registration issues
  • Complies with AHIMA standards of ethical coding and coding compliance guidelines
  • Demonstrates support and compliance with University of Maryland Medical Center Midtown Campus’ mission, vision, values, philosophy, goals, objectives and policies
Qualifications for certified coding specialist
  • HCC coding experience a plus
  • Demonstrates support and compliance with University of Maryland Medical Center Midtown Campus’ Customer Service Standards
  • Two (2) years inpatient coding experience in an acute care setting required, and ICD-10 and CPT4 experience required
  • Analyze medical information in the medical record and assign/sequence the correct ICD-10-CM, CPT, and/or HCPCS code to the diagnoses/procedures of office, inpatient and/or outpatient medical records, including operative reports, according to established coding guidelines
  • Knowledge of surgical coding and the ability to review
  • Code complex operative procedure reports
4

Certified Coding Specialist Job Description

Job Description Example
Our growing company is hiring for a certified coding specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for certified coding specialist
  • Responsible for remaining up-to-date with knowledge of AHA ICD-9-CM/ICD-10-CM/PCS and AMA CPT-4 coding conventions, MS-DRG and APR-DRG principles and guidelines
  • Interact with and provide support to facility staff to answer questions and resolve rejected charge tickets and claims
  • Utilize medical reference resources and contacts to thoroughly research coding issues and to maintain working knowledge of coding guidelines and LCDs to ensure maximum reimbursement and coding compliance
  • Identify opportunities for billing/coding improvements
  • Take responsibility for various projects as assigned by management and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability
  • Works with the Audit & Compliance Specialist to produce and analyze statistical data for residents and faculty, to create training materials for periodic resident/faculty training sessions
  • Stays abreast of any changes to coding protocols as it relates to ICD-10 codes, CPT codes and modifiers
  • Assists with daily operations and resolving issues and billing/coding discrepancies
  • May abstract pertinent information from patient records
  • Adhere to internal department policies and procedures to ensure efficient work processes
Qualifications for certified coding specialist
  • 1 year full time certified coding specialist experience in a health care setting within the last 2 years
  • AAPC or AHIMA certification is required in ICD-10
  • Minimum of 2-3 years’ experience working in a hospital or physician’s office as a medical coder
  • 2 years of surgical coding strongly desired
  • Expert knowledge of ICD10, CPT, and HCPCS necessary
  • Basic computer skills required, knowledge of Cerner PowerWorks a plus
5

Certified Coding Specialist Job Description

Job Description Example
Our company is growing rapidly and is looking for a certified coding specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for certified coding specialist
  • Supervises staff including assignments and Kronos approval and sign offs, , assist with recruitment
  • Analyze medical information in the medical record and assign/sequence the correct ICD-10-CM, CPT, and/or HCPCS code to the diagnoses/procedures of office, inpatient and/or outpatient medical records, according to established coding guidelines
  • Research pre bill reports to correct or complete encounters while identifying trends that may cause interference with finalizing completion status
  • Reviews and selects appropriate ICD-10 and CPT codes
  • Identify principal and secondary codes for oncology services
  • Requests clarification or obtaining additional medical information provided by physicians
  • Responsible for accurate billing, staying current with ongoing updates to coding guidelines
  • As a Subject Matter Expert (SME), develop pertinent Medical Coding to prepare students for the CCS exam
  • Ensure quality standards within all courses
  • Assists in second level support related to course design and structure
Qualifications for certified coding specialist
  • Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) OR Active RN
  • Graduate of an Accredited School of Nursing, OR, successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC)
  • 1 year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation
  • Two (2) years of hospital outpatient and ambulatory coding experience
  • Strong knowledge of ICD-10-CM and/or CPT
  • Required High School Diploma required (Associates Degree preferred)

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