The Coding Specialist reviews superbills and corresponding medical record documentation to assign appropriate CPT, HCPCS, modifiers, and ICD-10 codes, and post charges to achieve maximum reimbursement following OSNI protocols and CMS and private payer guidelines.
Core responsibilities include daily charge posting after billing and diagnostic code assignment, reviewing first level rejected claims, using hospital portals to obtain operative reports and patient demographics, scanning completed work into SRS, querying physicians and medical staff for record clarification, ensuring provider amendments as needed, and participating in provider coding review sessions.
Qualifications include a high school diploma or equivalent, RHIT, CPC, or CCS certification, preferably an associate degree or higher in coding or health information management, accounting, or business administration, data entry skills (50-60 keystrokes/min), at least one year of coding or billing experience in healthcare or financial services, knowledge of insurance programs and billing processes (CMS, Anthem, UHC), and proficiency with medical terminology and coding systems (ICD-10, CPT, HCPCS).
The role requires excellent communication, organizational skills, attention to detail, and time management.
The specialist performs all coding functions per state, federal, and payer guidelines, reviewing medical records for proper code utilization, querying providers as needed, coordinating with the Business Office team, entering charge data accurately, managing first level claim rejections, printing and mailing claims, maintaining knowledge of coding guidelines and regulations, and collaborating with multiple departments to clarify discrepancies.
May prepare reports, assist in training new employees, cross-train in departmental functions, and uphold ethical standards and compliance.
Physical requirements include extended periods of computer work, filing, lifting office supplies, keyboarding, prioritizing work, multitasking in a sometimes stressful environment, and strong problem-solving skills.
- High school diploma or equivalent
- RHIT, CPC, or CCS required
- Associate degree or higher preferred
- Data entry skills (50-60 keystrokes/min)
- Minimum one year healthcare or financial coding/billing experience
- Knowledge of CMS, Anthem, UHC billing processes
- Familiarity with medical terminology, anatomy, physiology, ICD-10, CPT, HCPCS coding
- Excellent communication and organizational skills
- Attention to detail and time management
Location
Indiana, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 months ago