Medical Coding Specialist - FT40

Department:Eldorado Primary Care

Immediate Supervisor:CNO

Position Status:FT

Hours per week:40



JOB TITLE:    Medical Coding Specialist – Clinics   

The Medical Coding Specialist - Clinic will have frequent and daily interactions with internal and external clients including but not limited to Physician and Non-physician Providers and staff as well as various third party payors to include Medicare and Medicaid. Responsibilities include diagnostic and procedural coding for the various primary care clinic services as well as inpatient and nursing home encounters.  The Medical Coding Specialist - Clinic focuses their work on detailed physician documentation for improvement and optimization of physician coding practices for compliance and revenue. The Medical Coding Specialist shall possess extensive knowledge of Physician Quality Reporting System (PQRS).  Responsible for reviewing claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plans, such as educational programs, to prevent similar denials and rejections from recurring.  Develop a close working relationship with physicians and their office staff as well as all outpatient departments related to hospital coding and reimbursement. 

Provide education/training to physicians and other providers on coding and clinical documentation. Consult with and educate/train physicians on coding practices and conventions in order to provide detailed coding information for encounters. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to providers as it pertains to proper coding and clinical documentation of services performed.

Participate in the development of coding policies and procedures as identified. Assist with research and development of presentation materials for continuing education programs for physician in their areas of specialization.  Intermediate to advanced experience with Microsoft Office including PowerPoint and Excel required.  Excellent written and verbal communication skills with the ability to work with minimal supervision. 
Possess a strong understanding and working knowledge of anatomy, physiology, and medical terminology along with a strong attention to detail.  Produce consistently accurate work, with professionalism at times under pressure.  Ability to prioritize and organize work area despite multifaceted task directions and interruptions. 

Interact and provide high-level analysis of trends to Practice Administrator and other Managers regarding coding related issues. Research and identify trends in unbilled accounts. Contacts appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures with providers and managers. Possess a knowledge and understanding of coverage decisions by payor and communicate these guidelines to providers and staff. 

Previous audit experience preferred.

Perform other related duties incidental to the work described herein.

Education: Bachelor degree in medical record administration or associate degree in medical record technology, and certification in one of the following: Certified Coding Specialist (CCS), Certified Professional Coder (CPC).
Experience: At least 3 years of experience in a physician medical practice with experience in CPT, HCPCS, ICD-9 and modifiers.  Expertise in auditing and ICD10 along with experience coding services in a multi-specialty physician environment preferred

Physical Demands: 
        1. Visual, auditory and communication acuity. 
        2.  Moderate walking, standing, stooping, bending and lifting, 10 – 25 pounds.
        3.  Prolonged sitting in review of records and computer operation.
        4. Prolonged telephone communication.

• Employment Type:          Full-Time
• Job Type Admin:             Clerical, Health Care
• Education:                        Bachelor degree preferred with Coding Certification
• Experience:                      At least 3 year(s)
• Manages Others:              Not Specified

• Industry Healthcare - Health Services, Managed Care