Summary

The Coding Specialist verifies billing information marked on the provider’s encounter form to the billing information in Electronic Medical Records (EMR), ensuring third party payer required diagnosis and modifier information is correct on the billing. Posts information from the encounter form in Group Management System following the Charge Entry Policy and Procedures to ensure clean claim submission.

Essential Duties and Responsibilities

• Reviews medical records, determines appropriate services to be coded (ICD-10-CM, CPT, and/or HCPCS) for each encounter.
• Reviews documentation for diagnosis coding specificity for Hierarchical Condition Category Coding.
• Organizes work for accuracy and effectiveness in order to ensure compliance of proper billing and coding procedures of third party carriers and to ensure complete and accurate reimbursements.
• Verifies procedure codes marked on the encounter form in EMR. All charges will be posted prior to closing the month in Group Management System.
• Work as a team to ensure all encounters are entered into Group Management in a timely manner and prior to the end of the month process.
• Reconcile payments with the deposit log completed by the clinic.
• Use hash totals to ensure all the Current Procedural Terminology (CPT) codes have been posted from the encounter form and balance to the Group Management audit journal.
• Ensures required diagnosis, referring physician and modifiers are entered for clean claim submission.
• Returns copies of questions, incomplete charge sheets and other problems to offices or physicians for resolution.
• Follows up on problems weekly to ensure they are corrected and returned timely.
• Communicates reoccurring problems to supervisor for resolution.
• Follows Charge Entry Policy and Procedures, complies with new changes as necessary.
• Researches, corrects and resubmits claims denied due to charge entry errors.

Other

• Compiles information and prepares reports.
• Maintains records.
• Participates in educational activities.
• Regular and in-person attendance as scheduled and required to perform essential job functions.
• Follows organizational policies and procedures, including State of Franklin Healthcare Associates Compliance Manual, Code of Ethics and Business Standards, HR Policies and Procedures Manual, Team Member Handbook, OSHA Manual and any other policies or procedures for the job function, department, location or clinic.
• Performs other duties as assigned.

Direct Reports

None

Qualifications

Knowledge of medical business office and coding procedures. Skill in using computer, calculator, copy and fax machine. Ability to examine documents for accuracy and completeness and prepare records in accordance with detailed instructions.

Education

High school diploma or GED

Experience

One to three years of CPT and ICD-10 coding and billing experience preferred.

Certificates, Licenses, Registrations

None

Competencies

Service: Demonstrates high standards of service to patients, physicians, team members and other departments; remains calm when faced with challenging or difficult situations; effectively resolves service issues.

Quality: Work is thorough and accurate; offers ideas and solutions to improve outcomes and enhance service; considers the situation and relevant information before taking action; effectively implements improvements.

Integrity: Acts with the highest levels of personal ethics, honesty and accountability.

Performance: Applies job specific knowledge, skills and experience to accomplish results; requires appropriate level of supervision; work is completed in a timely manner; uses sound judgement in decision-making; is reliable and dependable; utilizes time and resources responsibly; complies with policies and procedures; work area is organized, neat and clean.

Communication: Expresses facts and ideas in a clear, convincing and organized manner; listens effectively; professional, respectful and compassionate in communications with others; follows proper channels of communication and shares essential information timely; maintains appropriate confidentiality.

Teamwork: Builds and maintains effective working relationships; recognizes strengths and contribution of others; manages and resolves conflicts in a positive and constructive manner.

Working Conditions

Work is performed in a medical office environment involving contact with patients, physicians, staff, insurance carriers and other business partners. Occasional local travel between work sites and additional hours, including evening or weekend work, may be necessary.

Physical Requirements