Coding Specialist

Clinical Coding & Charge Entry

• Assign and sequence ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes based on clinical documentation.
• Translate patient transport data into billable charges and ensure billed services match documented medical necessity in the Electronic Patient Care Report (ePCR).
• Maintain knowledge of coding bundling, modifiers, and global periods to help prevent claim denials.

Demographic & Insurance Verification

• Audit patient information, including legal name, address, date of birth, and guarantor details for each claim.
• Verify insurance eligibility and primary, secondary, and tertiary coverage using clearinghouses and payer portals.
• Enter insurance details accurately to reduce front-end rejections.

Documentation Compliance & Send Backs

• Review ePCRs for signature compliance and missing clinical documentation.
• Flag incomplete records and prepare send-back tasks for clinical staff or providers.
• Monitor the send-back queue to ensure corrections are returned promptly.

Claims Resolution & Rebilling

• Research and resolve basic claim edits or denials related to coding or demographic discrepancies.
• Update account notes to reflect the status of rebilled claims and actions taken to address payment delays.

Systems Maintenance & Team Collaboration

• Perform data corrections within HealthEMS and other ePCR programs.
• Coordinate with providers, clients, and internal colleagues via email and Slack.
• Stay current on company processes and industry regulatory updates through department meetings.