Medical Coding Specialist II

Responsible for accurate and compliant assignment of CPT and ICD-10 codes supported by provider documentation in the medical record using the current year ICD-10 and CPT manuals to ensure optimal reimbursement.

Principal Job Functions

• Commit to the mission, vision, beliefs, and core values of Bryan Health/Bryan Heart.
• Adhere to all relevant Bryan Health/Bryan Heart policies and procedures.
• Accurately assign and sequence diagnosis and procedure codes to determine the correct Ambulatory Payment Classification assignment using provider documentation.
• Maintain coding certification through continuing education requirements defined by the certifying body/organization.
• Maintain a strong understanding of government and commercial payer documentation, coding, and reimbursement guidelines, including CCI edits, MUEs, NCDs, and LCDs.
• Meet departmental productivity and performance goals and metrics.
• Comply with the Bryan Heart Coder Audit/Competency Program.
• Analyze, research, and perform payer follow-up tasks related to coding denials, including bundling, medical necessity, and non-adherence to payer coding/reimbursement guidelines.
• Assist in monitoring payer denial trends and developing the denials management process.
• Advise the supervisor/director of concerns related to provider documentation, payer performance, system functionality, and other barriers affecting organizational goals and metrics.
• Provide timely feedback to providers regarding documentation concerns or inaccurate procedure code assignment.
• Participate in team meetings, committees, and department projects as assigned.
• Assist with auditing activities as requested.
• Review and report new, deleted, or inactivated procedure codes to appropriate team members.
• Complete mandatory annual training and maintain professional growth through seminars, workshops, and professional affiliations.