Coding Specialist

The Coding Specialist performs highly technical and specialized functions for the medical, dental, behavioral health, and outreach departments. This role involves reviewing, analyzing, and coding diagnostic and procedural information to determine Medicare, Medicaid, and private insurance payments. The primary duties include performing ICD-10-CM, CPT, and HCPCS coding for reimbursement, entering data from outside providers, and assisting the Billing Specialist.

Key responsibilities include maintaining patient confidentiality per HIPAA regulations, assigning and sequencing codes accurately, performing quantitative and qualitative analysis of provider documentation, verifying Evaluation & Management (E&M) coding accuracy, operating RPMS for data entry and updates, maintaining logs of chart deficiencies, assisting with follow-up on unpaid claims, and adhering to safety and policy procedures.

Qualifications include high school completion or equivalent, two years of coding experience using ICD-10-CM, and CCS, CCS-P or CPC certification (or obtain within six months of hire). Knowledge required includes medical terminology, anatomy, pharmacology, official coding guidelines (AMA and CMS), RPMS and IHS EHR systems, fiscal policies, and effective communication skills. A valid CPR card is required. Preference is given to Native Americans. Passing a pre-employment drug screen and physical clearance is mandatory.