Medical Coding Specialist

General Description

The Medical Coding Specialist will perform data reviews of patient records for the timely and accurate assignment of ICD-10-CM, CPT, CDT, HCPCS and DSM-5 codes and provide education to providers as needed.

Essential Functions

• Review appropriate ICD, CPT, CDT, HCPCS and DSM-5 codes for all visits in a behavioral health and medical setting for statistical reports and accurate reimbursement.
• Use CPT, CDT, ICD-10-CM, HCPCS and DSM-5, physician documentation and other approved resources to assign accurate procedure, diagnosis codes and modifiers to professional services.
• Ensure the LCHD facilities are paid for all reimbursable procedures completed.
• Code with 95 percent accuracy as determined by quarterly audits.
• Audit medical records for documentation accuracy and procedure review.
• Use Microsoft Excel to track the accuracy of providers and summarize review results.
• Assist in the development of coding protocols to ensure coding accuracy; review information about patient treatment, diagnosis and related procedures to ensure proper coding.
• Ensure documentation compliance with all coding mandates and reporting requirements.
• Evaluate clinical documentation to ensure quality, completeness and consistency as it relates to code selection and reimbursement and within the time period established by management.
• Maintain confidentiality of patient charts, medical information and physician information including profiles and fees (HIPAA Compliance)
• Serve as a resource providing education to providers, and administrative staff on professional coding issues
• Attend appropriate in-service education, staff meetings and seminars appropriate for professional development.
• Use computer software applications to read and organize charts.
• Ongoing involvement in quality improvement activities.
• Assist with other projects and duties as assigned.

Knowledge Skills Abilities and Education Required

• Minimum one-year coding and billing experience in a medical outpatient clinical setting for Medical Services position.

• Completion of a high school diploma or G.E.D.

• Certification of CCA, CCS, CCS-P, COC, CPC and/or an RHIT, active membership affiliation with AAPC and/or AHIMA, and a minimum of one-year recent medical coding/billing experience.

• Thorough understanding of the correct use of ICD-10-CM, CPT, CDT and HCPCS codes as related to what is needed and accurate for multiple types of medical, behavioral health, chemical dependency and dental health services.
• Extensive knowledge of the rules, regulations, and requirements of medical billing to Medicare, Medicaid and private insurance.
• Knowledge of federal regulations pertaining to billing for medical, dental and behavioral health services provided by a Federally Qualified Health Center.

• Demonstrated knowledge of coding and documentation required for billing and reimbursement in an electronic health record system.
• Understanding of community/private mental health center billing guidelines.
• Ability to produce reports to use for analyzing data in Microsoft Excel
• Possess thorough knowledge of documentation requirements, sequencing, modifiers, unbundling edits and physician billing issues.
• Ability to work in a respectful, professional, courteous manner with providers, coordinators, co-workers and patients.
• Ability to work independently in a fast-paced environment.

Supplemental Information

As the largest human service provider in Lake County, we believe that services must be available without barriers. No residents are turned away due to the inability to pay. We believe in providing services in an environment of mutual respect, free of discrimination or bias. Whether assuring accessible and effective care, impacting policy, or assessing and monitoring risks, the Lake County Health Department and Community Health Center has been an essential part of the public health system in Lake County for 60 years. We are looking for passionate, qualified team members who can help make a difference in our agency and, most importantly, in our community.

Additional information about the Lake County Health Department, our culture, and why you should join our team can be found athttps://lakecountyil.attract.neogov.com/health-department.

At this time, you must live in Illinois or Wisconsin to be eligible to work at Lake County Health Department. You can find our salary grades at https://www.lakecountyil.gov/4515/Salary-Grades. For unionized positions, a list of our collective bargaining agreements can be found here: https://www.lakecountyil.gov/2686/Collective-Bargaining-Agreements."

Any offer of employment is conditioned on the successful completion of a background screening, drug and alcohol testing and may include a pre-employment medical exam.

The Lake County Health Department and Community Health Center is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sexual orientation, gender identity or gender expression, national origin, disability, veteran status, and other protected characteristics.