• Must have and maintain Certified Professional Coder certification (CPC) issued by the American Academy of Professional Coders, (AAPC)

Position Summary

The Certified Professional Coding Specialist is responsible for the accurate and timely review of claims for clean claim billing. Will evaluate medical records and charge entries to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-9-CM), (ICD-10-CM), (HCPS) level II code sets, and the American Medical Association’s Current Procedural Terminology Manual (CPT). The Specialist will also provide technical guidance and training on medical coding to physicians and staff. This role stays current on Federal, States and third-party health plans regulations and guidelines of services rendered, to assure all services meet the clean claims regulations to support timely and full reimbursement.

Duties and Responsibilities

• Ability to make professional and educated decisions on code correction issues for accurate billing.
• Evaluate medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to assign and sequence the correct ICD-10-CM and CPT codes accurately.
• Read progress notes to identify missing or inaccurate billing codes, missing documentation to communicate any education needs.
• Perform monthly random billing compliance audits of claims and progress notes to identify potential billing discrepancies.
• Makes recommendations for changes in policies and procedures; works with data processing staff to revise and update the EMR charge master file.
• Work with Manager in the development and updating of procedure codes in EMR systems to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.

• Review State and Federal Medicare reimbursement guidelines regarding clean claims guidelines for completeness and accuracy before submission to minimize claim denial.
• Evaluate records and prepare reports on such topics as the number of denied claims resulting from coding issues for review by management and/or professional evaluation committees.
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.

Minimum Qualifications

• High School Diploma or equivalent required.
• Associated degree in HealthCare Administration or similar preferred.

• Must have and maintain Certified Professional Coder certification (CPC) issued by the American Academy of Professional Coders, (AAPC), Certified Coding Specialist – Physician-based (CCS-P) Certified Professional Coder (CPC) designation.
• Must have 3 years of experience in medical record professional coding services
• Knowledge of ICD-9-CM, ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; and State and Federal Medicare reimbursement guidelines.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to read and interpret medical procedures and terminology.
• Ability to develop training materials, make group presentations, and to train staff.
• Ability to exercise independent judgment.
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
• Ability to maintain confidentiality.

Working conditions

This job operates in a remote location from your home location.  This role requires a dedicated, quiet workspace with the ability to adhere to HIPPA and other privacy policies.  A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.

Direct reports

None

All Employees are expected to maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company’s patients, employees, and business partners. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.  This description reflects management’s assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned.  This job description is subject to change at any time.