Coding Specialist Job Description

Coding Specialist Job Description

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Coding specialist provides training to healthcare professionals, and Revenue Cycle staff in ICD, CPT, HCPCS Level II coding guidelines, proper documentation guidelines and other information related to coding.

Coding Specialist Duties & Responsibilities

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

Sample responsibilities for this position include:

Review and respond to coding/billing questions from providers and staff
Conduct coding reviews and on-going training programs to assure coding quality
Review documentation on medical records from all service lines (ED, HM, PM, Clinic, Anesthesiology, others) and assign ICD-10 and CPT codes based on current and potential coding policies
Identify and explain differences in coding between the original coder, auditor and the coding specialist
Conduct new provider coding training
Research any coding issues
Research updated coding information
Attend the Compliance Committee and Central Billing Office meetings as needed
Assigns appropriate ICD-10-CM and or CPT-4 codes/modifiers upon review of the medical record documentation
5% coding error rate on audited records

Coding Specialist Qualifications

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

Licensing or Certifications for Coding Specialist

List any licenses or certifications required by the position: CPC, CCS, RHIT, RHIA, BLS, LIFE, ICD, CRC, COC, AHIMA

Education for Coding Specialist

Typically a job would require a certain level of education.

Employers hiring for the coding specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Medical, Health Information Management, Education, Nursing, Physiology, Anatomy, Medical Terminology, Technical, Supervision, Associates

Skills for Coding Specialist

Desired skills for coding specialist include:

Medical terminology
Anatomy and physiology
Physiology
Coding
ICD-10
Anatomy
Billing
Human anatomy
CPT/HCPCS and coding guidelines
Government regulations

Desired experience for coding specialist includes:

Knowledge in the use of 3M software
Assist in the oversight of compliance program and activities
Assist with establishing compliance policies in accordance with the Company's compliance strategies and priorities, and applicable laws, regulations, and industry codes
Monitor, and as necessary, coordinate compliance activities, to remain abreast of the status of all compliance activities and to identify trends
Coding certifications (CPC, CCS, CCS-P, CPMA, CEMC or CENTC)
Knowledge of the regulations and guidelines as they relate to documentation and coding

Coding Specialist Examples

1

Coding Specialist Job Description

Job Description Example
Our growing company is looking for a 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 coding specialist
  • Update documentation where changes are made to ensure ongoing coding is correct
  • Enters appropriate data into the Billing System by selecting the appropriate codes, diagnosis, modifiers, and physician information to complete the charge process
  • Provide education to the medical staff, clinical documentation specialists and hospital staff on documentation, coding and DRG assignment
  • Assist with establishing compliance policies
  • Codes all assigned inpatient and observation discharges within five days of discharge in 90% of audited cases
  • Individual daily productivity levels maintained within range of 28-31 inpatient cases (including Observation cases)
  • Build solid knowledge of product hierarchies and the restatement, alignment and new adds processes
  • Work in collaboration with our Commercial teams to assess client need, build and provide input into the specification and perform the requested changes according to the requested timelines
  • Answer ad-hoc data queries
  • Develop strong relationships across our teams particularly with Commercial and the SRM functions to provide support and insight
Qualifications for coding specialist
  • Performs coding of all Outpatient and AMB medical records using ICD-9-CM, CPT and software
  • CHC, CPCO and/or Bachelor's Degree
  • Bring a point of view to the table
  • Want to “make a difference”
  • Have a drive to succeed and develop
  • Analytical thinking – full understanding of the product, brand and retailer hierarchies to set the foundation for effective root cause analysis
2

Coding Specialist Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of 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 coding specialist
  • Performs clinical trial data coding activities according to the internal standards and regulatory requirements
  • Ensures correctness and consistency of coding within the dictionaries of allocated studies
  • Informs and suggests solutions on coding related issues of allocated studies
  • Produces coding listings for each dictionary of allocated studies for the review by the other functions
  • Interacts with other functions to improve the coding of allocated studies
  • Represents the Clinical Data Coding Group at Clinical Trial Team meetings for allocated studies
  • Meets study timelines in terms of coding activities
  • Provides training to Coding Specialist(s) if needed
  • Presents Coding related topics at Clinical Trial Team, Investigators and Monitors meetings
  • Forecasts coding group resource requirements
Qualifications for coding specialist
  • Time management – Accurate assessment of scope and forecasting of project duration
  • Ability to prioritise workload – identifying project conflicts and work with all affected parties to establish priorities and deliver against requirements
  • Excellent communication (both written and verbal) – Effective communication at the assessment stage to ensure scope is fully agreed and understood by all parties and throughout the project to ensure key stakeholders are informed of status vs
  • Confidence and presence to lead impactful and professional conversations with clients
  • One year of post-high school education or a degree from a two-year college
  • 1 year experience of ICD9/ICD10, CPT and HCPCS coding experience
3

Coding Specialist Job Description

Job Description Example
Our company is hiring for a coding specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for coding specialist
  • Participates in development and review of Quality System (QS) Documents for the Clinical Data Coding Group
  • Performs quality control to ensure correctness and consistency by review of coding listings
  • Research payer manuals for rules and regulations
  • Research current Team Health policies and procedures to ensure currency and accuracy
  • Research and development of needed policies and procedures for emergency medicine, hospitalist programs, clinic medicine, anesthesia and other Team Health specialties as required
  • Maintain division-specific and payer specific informational resources
  • Assist in the development of payer/carrier requirement database
  • Participation in the gathering and collation of payer/carrier requirements through survey process on routine basis
  • Assist Documentation Manager with duties as needed
  • Process insurance and patient refund requests as necessary and according to policy and procedure
Qualifications for coding specialist
  • EMR and Practice Management Software experience
  • Performs medical chart audits meeting minimum productivity standards and ensures proper chart documentation.*
  • 3 years of experience of ICD9/ICD10, CPT and HCPCS coding experience
  • Serves as a key contact and liaison with clinicians to answer coding questions.*
  • Provides individualized sessions with clinicians for specific coding issues based on medical chart audit results.*
  • Conducts coding classes for clinicians, clinical and business office staff.*
4

Coding Specialist Job Description

Job Description Example
Our company is hiring for a 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 coding specialist
  • Participate in review of Senior Billing Specialists’ claims
  • Act as a resource to the Senior Billing Specialists and other CBS and clinical staff members
  • Analyze and interpret patient medical records and assigns and sequences appropriate diagnostic / procedure billing codes in compliance with documentation and of third party payer requirements
  • Assist with the performance of clinical reviews with knowledge of body systems, anatomy and physiology
  • Interact with providers regarding billing and documentation policies, procedures, and regulations
  • Identify liability and guarantor hierarchy and transfer balances timely and appropriately
  • Research and resolve denials and underpayments with insurance carriers
  • Review and interpret Explanation of Benefits (EOB) for denials and underpayment of codes
  • Serve as primary customer service representative for payer inquiries/calls
  • Research, correct, and resubmit or reprocess unpaid claims as necessary
Qualifications for coding specialist
  • Works with key departments to review and explain medical chart audit results.*
  • Schedules offsite audits and organizes special project audits
  • Resources the regional coding hotline.*
  • Assists in training incoming department staff.*
  • Facilitates the Coding Intern program.*
  • HS grad or equivalent coupled with CCS, CCS-P, CPC, CPC-A, CCA, RHIT, and/or RHIA certification
5

Coding Specialist Job Description

Job Description Example
Our company is hiring for a coding specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for coding specialist
  • Discuss discrepancies regarding DRG assignment and/or secondary diagnoses with clinical documentation specialists within specified timeframe
  • Identify and interact with clinical documentation specialist/physician to solicit additional clinical information to assign optimal DRG
  • Interacts with Drug Safety group for reconciliation
  • Advises in the choice of the medical/project specific dictionaries to be used for allocated studies
  • Performs the migration of the standard dictionaries (Medical Dictionary for Regulatory Activities (MedDRA), World Health Organization Drug Dictionary Enhanced (WHO DDE) in accordance with the regulatory requirements
  • Interacts with the study team for support, on forbidden medication, WHODRUG Standardized Drug Groupings (SDGs), Standard MedDRA Queries (SMQs)
  • Contact payer representatives to discuss policy exceptions and make appeals to optimize reimbursement
  • Develop and maintain a thorough knowledge of the department's overall workflow with a general understanding of all functions and the importance of completing each task in a timely manner
  • Engage management to escalate issues when needed to assist in issue resolution
  • Perform reimbursement training for new coders
Qualifications for coding specialist
  • Minimum 2 years experience coding
  • Flexible, self-motivated and self-directed
  • 2 years Coding Training experience
  • 2 years of medical chart auditing experience
  • Proficient in Word, Excel, PowerPoint, Multi-media projector
  • Minimum of 5 years’ coding experience, with at least 3 with the Medicare Advantage program preferred

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