Certified Coding Specialist

The Certified Coding Specialist is responsible for planning, coordinating, and providing education to providers and clinic faculty related to clinical documentation, revenue optimization, and coding-related processes. They will apply their knowledge and expertise to stress the importance of accurate, timely and complete documentation to ensure appropriate payment for clinical services in accordance to all applicable laws and regulations.

• Monitors assigned work queues and completes assigned patient accounts in a timely manner to include coding, researching, correcting claims, querying providers as needed, and trending of coding educational opportunities.
• Codes all documented professional services for assigned service lines.
• Reviews and applies CPT-4, ICD-10-CM, HCPCS, DRG and applicable modifiers in accordance with coding guidelines to patient accounts.
• Adheres to official coding guidelines, AMA and CMS.
• Ensures coded services, provider charges, and medical record documentation meet coding guidelines and standards.
• Reviews clinical documentation and provider communication, supporting documentation, and evidence-based feedback to providers and other clinical personnel, based on identified opportunities for documentation improvement and/ or revenue optimization.
• Remains up to date on coding guidelines and reimbursement reporting requirements.
• Ensures timely charge review and processing of daily submissions.
• Serves as a primary source of contact to faculty and providers related to clinical documentation and coding-related questions and requirements to ensure compliance with applicable laws and regulations.
• Ensures review of patient complaints and insurance related inquiries are completed appropriately and timely.
• Creates, maintains, and provides coding educational training and reference tools to providers and clinical staff to improve efficiency, accuracy, and timeliness of documentation.
• Participate in projects related to coding and review applicable reports as requested.
• Participates in review and analysis of coding-related denials and adjustments and develops action plan to reduce avoidable write offs.
• Must adhere to FHLC policies and procedures.
• Regular and Reliable Attendance
• Other duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This position requires an individual to work independently as well as in a group setting. The individual must be able to work under pressure and professionally handle stressful situations. The individual must possess analytical skills as well as excellent problem-solving skills. The individual must always maintain patient confidentiality while performing job duties. The position requires the ability to establish and maintain effective working relationships with providers, other employees, as well as the general public.

• Work may require sitting or standing for long periods of time; also stooping, bending and stretching.
• Occasionally lifting files or paper weighing 25 pounds or more.
• Requires manual dexterity sufficient to operate a keyboard, telephone, copier and other such equipment.
• Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.

• Work is performed in a medical clinic or office setting.
• Involves frequent contact with people.
• Interactions with others are frequent and interruptive. Work may be stressful at times.
• Work schedules may be changed to accommodate departmental/facility needs.
• The noise level in the work environment is moderately quiet.

Bilingual (Spanish) Preferred. Ability to read & interpret documents, reports & correspondence. Ability to speak effectively before groups and/or individuals. Working Knowledge of MS Office.