Medical Coding Specialist
Position Summary
The Coding Specialist is responsible for accurately converting inpatient, outpatient, and clinic diagnoses, procedures, and related services into appropriate ICD‑10, CPT, and HCPCS codes. This role ensures compliant, precise coding that supports optimal reimbursement and strengthens the overall revenue cycle. The Coding Specialist reviews documentation, assists with coding quality initiatives, provides guidance to coding staff, and collaborates with clinical and administrative teams to maintain accuracy and compliance. This position reports directly to the Revenue Cycle Director.
Principal Duties & Responsibilities Coding Accuracy & Compliance
- Apply ICD‑10, CPT, HCPCS, and APC codes accurately for routine and complex procedures while meeting or exceeding established quality and productivity standards.
- Maintain current knowledge of CMS regulations, payer requirements, AHA Official Coding Guidelines, and AMA CPT guidelines.
- Monitor regulatory and payer updates that impact documentation, coding, and reimbursement to ensure ongoing compliance.
- Review authorizations and pre‑billed claims to confirm alignment with documented procedures.
Quality Review & Reporting
- Assist the Business Office Manager in developing reports that summarize coding review findings.
- Gather and analyze data to support coder performance evaluations.
- Identify trends, recurring issues, and opportunities for process improvement.
Support & Collaboration
- Serve as a resource for coders, clinicians, and related departments by addressing questions related to coding, charging, DRG/APC assignments, modifiers, and special projects.
- Provide recommendations to the Business Office Manager regarding workflow, policy, or system adjustments based on coding regulations and payer requirements.
- Act as a liaison to ancillary departments, administration, and physicians, offering coding expertise and support as needed.
Denials Management
- Collaborate with the denials management team to identify root causes of recurring denials related to documentation or coding.
- Support denial prevention initiatives by engaging clinicians and ensuring documentation accuracy.
- Assist in resolving coding‑related denials.
Education & Training
- Assist in developing and coordinating educational plans and training sessions for coders, clinicians, and related departments.
- Monitor documentation turnaround times and follow up on uncoded accounts or documentation needs.
Professional Standards
- Maintain current coding credentials/licensure.
- Uphold confidentiality and compliance standards at all times.
- Perform other duties as assigned.
Position Qualifications
Education
- High School Diploma or equivalent (GED) required.
- Must hold an active coding certification: CPC, RHIA, RHIT, or CCS.
Experience
- Three to five years of medical coding experience required
Knowledge, Skills & Abilities
- Strong knowledge of CAH/RHC coding.
- Excellent problem‑solving and conflict‑resolution skills.
- Highly detail‑oriented with the ability to synthesize complex information.
- Strong time‑management and prioritization abilities.
- Ability to follow and provide detailed instructions.
- Thorough understanding of ICD‑10, CPT, HCPCS, and CMS guidelines.
- Proficient in medical terminology, anatomy, and physiology.
- Ability to interpret complex clinical documentation.
- Strong written and verbal communication skills, including the ability to clarify diagnoses/procedures with physicians.
- Ability to collaborate effectively with individuals who hold diverse perspectives.
- Skilled in navigating practice management systems to identify and resolve information gaps.
Knowledge, Skills & Abilities
- Reports directly to the Revenue Cycle Manager.
- Fully remote and hybrid positions are available. Competitive benefits and flexible schedules are offered.