What are the responsibilities and job description for the Coding Specialist position at Nottawaseppi Huron Band of the Potawatomi?
JOB TITLE: Coding Specialist
Supervisor: Business Office Manager
Status: Non-Exempt
Salary: Grade 5 ($23.03 - $24.47 hourly)
Location: The primary location for this position will be whichever location is closest to the selected candidate's residence.
Posting closes: 04/02/2025 9:00am
Excellent Benefit Package
- Eligible for Public Student Loan Forgiveness (PSLF) program
- Excellent medical coverage plan supplemented by Employer's HRA for minimal cost sharing by its Team Members
- 100% Employer Paid premiums for dental and vision coverage
- 100% Employer Paid premiums on short term disability, life insurance and accidental death and dismemberment
- Flexible Spending Account for Medical Reimbursement and Dependent Care
- 401K Plan with eligible match with 100% invested in employer contributions
- A generous paid time off program where all employees begin earning accrued paid time off immediately upon hire
- Generous Tuition Reimbursement Program with Educational Release Time
- Thirteen Paid Holidays
- Employee wellness and fitness programs
- Opportunities to participate in NHBP Sponsored activities
POSITION SUMMARY
Under the direction of the Business Office Manager, the Coding Specialist is responsible to accurately and completely code outpatient medical, behavioral health, and dietary procedures by reviewing clinical documentation and diagnostic results, as appropriate, to extract data for billing, internal and external reporting, research and regulatory compliance as documented in all AMA procedural and diagnostic official guidelines for coding and reporting.
ESSENTIAL FUNCTIONS
The Nottawaseppi Huron Band of the Potawatomi reserves the right to change, amend, add, delete and otherwise assign any and all duties, responsibilities, and positions titles as it deems necessary to meet the needs of the government. The below statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.
- Performs quantitative analysis by reviewing records to assure the presence of all component parts such as patient and record identification, signatures and dates required, and the presence of all reports which appear to be indicated by the treatment rendered.
- Performs qualitative analysis by evaluating the record for documentation consistency and adequacy. Ensures the final procedures and diagnoses accurately reflect the care and treatment rendered. Reviews the records for compliance with established third-party reimbursement agencies.
- Makes the final determination that medical legal requirements of the record are complete, accurate and reflects sufficient data to justify the procedures and diagnoses and warrant treatment and end results.
- Identifies inconsistencies, discrepancies and or trends within the medial record and discusses with appropriate medical, nursing, or healthcare providers, and recommends appropriate modifications to include medical necessity under the correct coding initiative.
- Assigns and sequences a variety of codes including but not limited to ICD-10, CPT, HCPCS codes based on the medical record analysis. Assures the final diagnoses and operative procedures as documented by the provider are valid and complete. When multiple diagnoses and procedures are listed, assures the procedure is related to the proper diagnosis.
- Analyzes provider documentation to assure the appropriate Evaluation and Management levels are assigned using the correct CPT/HCPC code.
- Provides ongoing education, updates and briefing for the medical staff, Business Office staff and other health care providers on changing coding conventions, rules, regulations and guidelines.
- Supports audits aligned with NHBP HHS Department Compliance Plan and Performance Improvement initiatives. This may involve reviewing provider documentation trends, conducting coding peer reviews, and addressing reimbursement denials. Delivers detailed reports, feedback, and educational resources to relevant stakeholders.
- Assists in development and modification of NHBP documentation and coding compliance policies and procedures.
- Code all diagnoses, treatments, and procedures by translating physician and nursing documentation according to the appropriate classification system for the category of patient encounter.
- Maintain coding accuracy benchmarks based on federal regulations.
- Maintain coding productivity within standards as established by record type.
- Maintain continuing education credits for compliance regulations and credential requirements.
- Assist providers and other direct patient care professionals in questions regarding level of detail for diagnostic entries, according to the organization’s policies and procedures.
- Responsible for keeping up to date on compliance notices on NHBP’s participating third party payers’ reimbursement policies, regulations and accreditation guidelines.
- Provides back up support to Billing and Accounts Receivable departments.
- Participate in departmental quality standards.
MINIMUM REQUIREMENTS
An applicant’s education, training and experience must be sufficient to demonstrate that the applicant possesses the ability to successfully perform each of the essential functions. The requirements listed below are generally representative of the education, experience, and skills and/or ability required to enable one to successfully perform the essential functions associated with his position:
- RHIT, RHIA, CCS, CCS-P, CPC or other professional HIM coding certificate.
- Two (2) years’ experience coding professional claims.
- Coding software and other computer software experience.
- Must maintain a valid driver's license with good driving record; GSA certifiable to travel.
- Must be able to successfully complete and pass a comprehensive background investigation and drug screening in accordance to NHBP standards.
- Must be CPR/First Aid certified or become certified as training is made available.
- Must possess strong administrative, organizational, and communication skills, both verbal and written.
- Must have exceptional computer skills, including word processing and spreadsheets, and knowledge of other office equipment required.
- Must possess excellent interpersonal/human relation skills.
- Must be able to maintain strict confidentiality and have knowledge of HIPAA requirements.
- Must always present in a professional demeanor and appearance.
OTHER SKILLS AND ABILITIES
- Able to understand, gain knowledge and appreciate the difference of Native American culture and customs.
- Willingness to develop a comprehensive understanding of Trauma Informed Care and ability to apply knowledge to daily functions.
- Ability to comprehend and abide by Tribal, Federal and other regulatory codes.
- Strong ability to organize and maintain electronic and physical files.
- Ability to read and interpret documents.
- Ability to be self-directed and be an excellent problem solver.
- Ability to work well in a team centered environment with or without immediate supervision.
- Ability to work with constant interruptions and organize/prioritize duties.
- Ability to foster a positive work environment.
PREFERRED QUALIFICATIONS
- Two (2) years’ experience with NHBP’s current EHR system.
- Certified Professional Medical Auditor (CPMA), Certified Document Expert Outpatient (CDEO), or equivalent certification.
SECURITY SENSITIVE
This position will involve access to information that is security sensitive and thereby subject to additional provisions. All information obtained will be protected under IHS/HIPAA policy rules and regulations.
INDIAN PREFERENCE
Tribal preference will be applied in accordance with the NHBP Indian Preference in Employment Code which requires that preference in employment be afforded to NHBP members, spouse/parents of NHBP members and Native Americans who meet the minimum qualifications and can successfully perform the essential functions for the position.
Fair Employment Practices Code (FEPC)
All applicants are subject to a comprehensive background check and must pass a drug screen.
NHBP does not recognize the use of recreational or medical marijuana.
Salary : $23 - $24
