Coding Specialist-CBO

Assigns accurate ICD diagnosis codes, using compliant documentation.

Assigns accurate CPT/HCPCS codes to records, using compliant documentation.

Applies knowledge of Coding Guidelines to select the appropriate diagnosis code.

Uses available research and reference tools to understand the disease process and diagnosis.

Interprets physician documentation within the coding guidelines and obtains clarification from physicians regarding vague or ambiguous record documentation.

Enhances coding knowledge and skills with continuing education activities.

Responsible for coding claims for professional fees for practice based physician practices or other entities.

Reviews professional documentation for accurate CPT and ICD-9 coding and compliance with government regulations.

Codes/abstracts all necessary information from health records to identify secondary complications and comorbid conditions.

Performs a comprehensive review of the documentation to assure the presence of all component parts such as: patient and record identification, dates where requested, and other necessary data documented on all reports, indicated by the nature of the treatment rendered.

Evaluates the record for documentation consistency and adequacy.

Ensures 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.

Queries physicians/providers when documentation is unclear to enable assignment of codes that are most specific and accurate for disease/operative indices and to support accurate billing for services delivered.

Codes only diagnoses and procedures documented in health record by physician or provider.

Queries physician/provider if documentation is unclear, questionable or if clarification is needed.

Accesses, uses or discloses PHI only when necessary to perform official job duties.

High School diploma or equivalent required

Associate's Degree preferred

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Must have thorough understanding of ICD-10 Official Coding Guidelines for Coding and Reporting and AHA Coding Clinic; HCPCS/CPT coding systems and CPT Assistant and Coding Clinic for HCPCS guidelines; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC).

Certifications:

CPC required

AAPC certification preferred

1-3 years working in a healthcare setting preferred. Prior coding of physician services using CPT and ICD-10 codes strongly preferred.