Clinical Coding Specialist

Community-University Health Care Center

Job Description:

The Clinical Coding Specialist will have responsibility for the coding and coding compliance function including: maintaining
a coding compliance and monitoring program, auditing charts and applying appropriate ICD10 and other codes, educating
and training providers on coding issues, maintaining current resources regarding coding guidelines for Medicare/Medicaid
and other third party payers

M-F, flexible hours
Full-Time Employee

Coding-analyze supporting medical record documentation for all professional services to ensure that appropriate CPT,
HCPCs and ICD-10 codes are assigned.
• Review medical record documentation and accurately assign ICD-10, CPT, and HCPCS codes, according to established
correct coding guidelines and AHIMA’s standards of ethical coding.
• Provides individual and group feedback and education to physician/providers, medical staff and other staff as a result of
the medical record documentation reviews.
• Consult with medical providers for coding and documentation clarification when necessary.
• Review insurance denials with coding discrepancies.
• Answer coding questions from providers and other staff as needed.

Monitoring-track and report on coding compliance of other coders and providers
• Develop and maintain a plan for monitoring and tracking of coding and coding compliance activities.
• Conduct prospective and retrospective coding reviews.
• Review coding for the scope of visits as dictated by the coding policy.
• Ongoing review and tracking of coding rejections/denials by insurance.
• Provide statistical (benchmark) findings on quarterly basis to physicians and administration.
• Works in conjunction with administrative team to evaluate any special requests for review of appropriate coding due to
patient complaints, denials, rejections, incorrect coding, etc., and provide feedback to inquiring source.
• Ensure all supply and drug charges are being captured.


All required qualifications must be documented on application materials. 

• Bachelor’s degree or a combination of education and relevant administrative experience totaling four years.
• CCS-P or CPC certification

Knowledge of:
• Medical terminology.
• CPT, ICD10-CM and HCPCS Coding systems.
• Health information and medical record documentation, data integrity and quality.
• Basic understanding of Medicare/Medicaid billing rules and other Federal regulations for billing and third party insurer
billing policies and contract requirements.
• HIPAA regulations

• Minimum of 2 years as a practicing outpatient/clinic coder.
• Certified Coding Specialist-Physician-based (CCS-P) – certification – preferred.
• Experience with Medicare, Medicaid and other third party payer reimbursement.
• Knowledge of State and Federal laws governing billing and coding practices.
• Excellent written and verbal communication skills.
• Ability to positively interact with physicians, providers and staff.
• Ability to organize work efforts and follow through on projects independently.
• Ability to maintain confidentiality.
• Presentation skills.
• Monitor proper use of Evaluation and Management levels of service.
• Problem solving skills.
• Experience in monitoring coding related compliance programs desired.

Instructions for Resume Submission:

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