Under general supervision and reporting to the Executive Director of Revenue Cycle, the Clinical Coding Specialist codes, reviews and reconciles professional clinician charges for hospital-based services using International Classification of Disease 10–Clinical Modifications (ICD-10CM) and Current Procedure Terminology (CPT) coding methodology in accordance with official coding and reimbursement guidelines.  Abstracts all data elements into the Medaptus for billing and statistical purposes.  Maintains current working knowledge with all coding rules and regulations.

Minimum Qualifications:

Education: 

• High School diploma or equivalent preferred.
• Associate or bachelor’s degree in an AHIMA or AAPC approved program preferred.

Experience:

• Completion of a Coding Certification program or Health Information Technology Program required.
• Experience in coding, billing, and knowledge of insurance reimbursement policies and regulations or equivalent experience is preferred but not required if one has completed a Coding Certificate or Health Technology Program.

Licensure and/or Certification:

• Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC®, CPC-H, CCS, CCS-P.

Skills: 

• Proficient in ICD-10, CPT®, HCPCS, and modifiers for coding of professional fee services.
• Working knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
• Accuracy and attention to detail
• Proficient with computer applications (MS Office etc), good data entry skills
• Working knowledge of medical terminology, anatomy and physiology, and disease processes.
• Understanding of Federal, State and payer-specific regulations and policies pertaining to documentation, coding, and billing.
• Ability to read and interpret regulatory guidelines regarding proper coding and documentation.
• Strong computer skills to include MS Office tools (Word, Excel, PowerPoint, and Outlook).
• Meditech and Medaptus experience preferred. Extensive use of computer and office equipment including fax, copy machines, scanners.
• Technical skills to work with detailed systems, computer applications and intradepartmental units.
• Knowledge of JCAHO requirements and federal and state guidelines applicable to health record completeness and patient privacy.
• Knowledge of health information systems and data management
• Knowledge of health record content and sequence.
• Strong analytical and communications skills; detailed oriented.
• Ability to accept constructive analysis based on feedback from inside/outside auditors, and quality improvement initiatives.
• Ability to use judgment in carrying out all phases of the work.
• Ability to maintain confidentiality regarding all phases of the work.
• Ability to be courteous, tactful, and cooperative throughout the working day.
• Ability to process and provide accurate paperwork.
• Ability to process work within presented deadlines and time frames.
• Ability to manage multiple projects and large amounts of data.
• Ability to work independently as well as a team player.
• Demonstrated interpersonal and communications skills to ensure effective outcomes in dealing with the medical staff and other hospital employees.