Job Title: RCM Coding Specialist

Must reside in the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

Job Summary

The Medical Coding Specialist will evaluate medical records and charge tickets to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-10-CM), and the American Medical Associations Current Procedural Terminology Manual (CPT). The Specialist will also provide technical guidance and training on medical coding to physicians and staff.

Duties and Responsibilities

Evaluate medical record documentation and charge-ticket coding to optimize reimbursement by ensuring diagnostic and procedural codes, and other documentation, accurately reflect and support outpatient visits via data compliance with legal standards and guidelines.

Review medical records and both identify and address any documentation or charge discrepancies.

Interpret medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM and CPT codes.

Perform edit checks on data entered prior to transmittal and corrects errors as indicated.

Research, analyze, recommend, and facilitate plans of action to correct discrepancies and prevent future coding errors.

Provide 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 codes that do not conform to approved coding principles and guidelines.

Assist lead or supervisor in educating and advising staff on proper code selection, documentation, procedures, and requirements.

Develop and update procedure manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.

Read bulletins, newsletters, and periodicals, and attend workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.

Participates in team meetings and activities to support the goals of the team and department.

Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

Performs other duties that may be necessary or in the best interest of the organization.

Education, Licensure & Certification Requirements

High School Diploma 

CPC, RHIT, or CCS Coding Credentials 

Experience Requirements

Minimum Required: 2+ years of medical coding experience OR completion of A.A. or A.S. in medial coding and billing, medical administration, or a related field

Knowledge, Skills and Abilities Requirements

Knowledge of ICD-10-CM and CPT coding guidelines, medical terminology, and both state and federal Medicare reimbursement guidelines.

Experience with the utilization of modifiers and other coding rules to include the AMA and other coding organizations.

Ability to research and analyze data, draw conclusions, and resolve issues by reading, interpreting, and applying policies, procedures, laws, and regulations.

Ability to develop training materials, make group presentations, and to train staff.

Ability to apply and understand payer requirements.

Professional in appearance and actions

Logical and Critical thinking skills

Customer-focused with excellent written, listening and verbal communication skills

Enjoys learning new technologies and systems

Detail oriented, professional attitude, reliable, prioritizing tasks to meet department goals.

Exhibits a positive attitude and is flexible in accepting work assignments and priorities

Meets attendance and tardiness expectations

Management and organizational skills to support the leadership of this function

Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

Interpersonal skills to support customer service, functional, and teammate support need

Able to communicate effectively in English, both verbally and in writing

Ability for basic to intermediate problem solving, including mathematics

Intermediate to Advanced computer operation

Proficiency with Microsoft Excel, Word, PowerPoint and Outlook

Travel to other site locations may be necessary. Thus, those needing to travel for work must have access to dependable transportation, and driving record must meet company liability carrier standards

Specialty knowledge of systems relating to job function

EHR Software

Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines