The Coding Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Coding Specialist performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 9 (ICD9) coding through abstraction of the medical record. This position trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the role’s core function.
Responsibilities:
- Abstracts and codes physician professional services and diagnosis codes (inpatient admissions, outpatient procedures, diagnostic services).
- Assigns appropriate CPT and ICD9 codes.
- Completes coding and billing worksheet.
- Ensures charges are captured by performing various reconciliations (procedure schedules, clinical system reports, fatal edit reports).
- Provides documentation feedback to physicians.
- Maintains coding reference information.
- Trains physicians and other staff regarding documentation, billing and coding.
- Reviews and communicates new or revised billing and coding guidelines and information.
- Attends meetings and roundtable, communicates pertinent information to physicians and staff.
- Resolves pre-accounts receivable edits, monitors reasons for missed billing opportunities, maintains non-compliance logs, identifies repetitive problems, works with physicians to resolve.
- Deletes incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers.
- Drafts letters and coordinates appeals.
- Works with Revenue Cycle staff and Account Inquiry Unit staff as requested, assists in obtaining documentation (operative reports, etc.).
- Provides invoice disposition instruction.
- Provides additional code and modifier information.
- May perform other duties as assigned.
Competencies/Performance Expectations:
- Please refer to NMHC Performance Standard Competencies.
- Maintains up-to-date knowledge, understands, and implements coding rule updates.
- Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff and other customers.
- Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.
- Ability to effectively handle challenging situations.
- Ability to balance multiple priorities.
- Excellent verbal and written communication skills.
- Ability to use personal computers and select software applications.
- Ability to analyze data for decision making purposes.
- Strong computer skills, including Microsoft Office, Outlook and database entry.
- Ability to maintain a high degree of confidentiality.
- Ability to adapt to changes in work environment, delays or unexpected events.
- Demonstrates attention to detail and monitors own work for accuracy.