INTRODUCTION

Under the supervision of the Medical Coding Manager, the Medical Coding Specialist is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The Medical Coding Specialist also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

Major Duties/Essential Functions

Essential and other important responsibilities and duties may include, but are not limited to the following:

• Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Supports the Medical Coding Manager to respond to audit findings and make applicable coding additions or corrections.
• Registers and analyzes claims in the EMR system, including insurance verification and charge entry. Tracks and requests outstanding claims for assigned departments/facilities
• Reviews Medicare Local Coverage Determination (LCDs) and Medicare bulletin updates.
• Utilizes the EMR system to run required daily/monthly/quarterly reports on claims entered.
• Accepts assignments from management and maintain open communication with their manager to resolve quality and production issues.
• Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third-party reimbursement agencies and special screening criteria.
• Complies with the rules and regulations of Medicare billing including (but not limited to) incident to, teaching situations, shared visits, consultations, and global surgery.
• Efficiently and accurately processes all types of claims utilizing broad based product or system knowledge to ensure timely payments are generated.
• Maintains strict confidentiality regarding confidential conversations, documents, and files.
• Supports the Medical Coding Manager to facilitates coding orientation for new providers.
• Ability to read and abstract physician office notes and procedure notes to apply correct ICD-9-CM, CPT,
  
  

HCPCS Level II and modifier coding assignments.

• Performs other duties as assigned.
  
  

Minimum Qualifications

• High School diploma or GED. Associates’ degree preferred.
• Three (3) years of experience using ICD-9-CM, Volumes 1- 3, CPT, HCPCS, and IHS coding conventions .
• CPMA, CFPC, CPC-P, or CPC certification required.
  
  

REQUIRED KNOWLEDGE, SKILLS AND EXPERIENCE

• Complete knowledge and understanding of UHC PM and EMR workflows.
• Must demonstrate ability to work independently with minimum supervision in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
• Advanced knowledge of medical codes involving selections of most accurate and description code using the extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Excellent oral, written, and telephone communication.
• Working familiarity with the rules and regulation pertaining to the FQHC guidelines.
• Ability to prioritize and manage multiple task with efficiency in dealing with multiple facilities.
• Ability to handle a large volume of project receiving and researching claims.
• Demonstrated ability to effectively work and communicate with diverse populations.
• Demonstrated proficiency with business software (e.g. Microsoft Office Suite).