Certified Coding Specialist I

POSITION DESCRIPTION

Reviews evaluation and management codes, modifiers, procedures, injections and diagnosis codes entered by physicians to ensure correct coding was entered by the physician. Facilitates appropriate billing for inpatient, outpatient, ER and special procedures, such as, but not limited to, OB deliveries, by reviewing the physician’s documentation to substantiate the level of coding.

Essential Job Functions

• Maintains complete knowledge and complies with all relevant insurance, CPT coding and diagnosis guidelines, disseminating information to staff and providers as necessary.
• Verifies provider chosen codes for non-invasive procedures.
• Runs daily reconciliation reports to ensure all charges are captured for each H&P, consult and discharge summary note entered into EPIC by physicians.
• Maintains query communication with providers to ensure timely notification of identified documentation issues that may impact revenue or compliance.
• Attends meetings with physicians and other clinical staff as required.
• Attends other regularly scheduled meetings.
• Creates relationships with external organizations that allow for streamlining and quick resolution of billing matters for patients.
• Captures special projects as assigned.

Organizational Expectations

• Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
• Must be able to work effectively as a member of the Revenue Site Operations team.
• Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.
• Embraces new ideas and respects cultural differences.
• Uses resources efficiently.

Essential Qualifications

• EDUCATION: High School Diploma or GED.
• CREDENTIALS/LICENSURE: One of the following certifications is required: AAPC (CPC, CPC-A), PMIC (CMC), AHIMA (CCS-P).
• MINIMUM EXPERIENCE: 2 years’ experience in a healthcare setting.

Position Requirements (abilities & Skills)

• Familiarity with billing and managed care department basic services and hours of operation to respond to customer requests accurately.
• Knowledge of medical, including surgical, terminology and procedures at the level needed to perform job responsibilities, including understanding of CPT and ICD-9/ICD-10 coding.
• Proficient/knowledgeable in the rules and regulations regarding insurance claim submission.
• Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation.
• Ability to use other software as required while performing the essential functions of the job.
• Excellent communication skills in both written and verbal forms, including proper phone etiquette.
• Ability to speak before groups of people, either in-person or virtually.
• Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
• Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, insurance carriers, outside customers, vendors and couriers.
• Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
• Good organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work.
• Ability to exercise sound judgement and problem-solving skills, specifically as it relates to resolving billing and coding problems.
• Ability to handle patient and organizational information in a confidential manner.
• Ability to work either remotely or in-office, as needed.
• Ability to drive to other office/practice sites and meeting and training locations.
• Ability to work under minimal supervision.