MEDICAL CODER

JOB OVERVIEW:

Under the direct supervision of the Project Director/Revenue Cycle Director, the Certified Coding
Specialist is responsible for the day-to-day activities and resolution of assigned medical claims
including denied, unpaid and underpaid accounts. The Certified Coding Specialist will utilize their
skills in denial analysis and resolution of coding related assigned accounts based on contractual
obligations.

Key Responsibilities:
The Certified Coding Specialist is responsible for the following areas:
• Reviews inpatient/outpatient medical records and assigned ICD-10-CM and PCS codes for
diagnosis, procedures, POA, etc. as assigned
• Thorough understanding and application of medical necessity, and DRG Coding
• Serve as a coding expert working with the Project Supervisor/Manager to ensure
compliance with Official Coding Guidelines for Coding and Reporting, coding conventions
and regulatory oversight agencies.
• Communicates directly with physicians for clarification as needed.
• Use of Coding applications like 3M, Encoder pro, Codify, etc. may be required.
• Responds to requests for data/information, such as outstanding queries, denials due to
coding, coding accuracy rates in a timely manner.
• Make internal recommendations, or recommendations to client on additional coding
opportunities/corrections.
• Provides coding expertise to staff members as needed on all issues relating to the accurate
and proper coding of patient medical information on bills submitted to Medicare, Medicaid,
commercial insurance providers, self-pay or any other third-party payers.
• Review remittance advices for denials and trends for the payers assigned. Referring all
payer issues/problems to Leadership in a timely manner, making recommendations to the Project Director/Revenue Cycle Director for resolution and elimination of denials where possible.
• Researching, reviewing and adhering to all federal, state and local regulatory guidelines, as
well as payer specific billing and coding guidelines.
• Participate in special projects or other responsibilities as needed or assigned.
• Follows Greenstone rules, policies, procedures, applicable laws and standards.
• Practice HIPAA compliance
• Attend staff and other professional meetings, including technical or professional classes,
workshops or seminars, to exchange information and improve technical or professional
skills.

Qualifications:
• High School Diploma or equivalent.
• Minimum 2 - 4 years of experience in hospital medical coding
• Successful completion of a certification program from AHIMA or AAPC
• Strong knowledge of Anatomy, Physiology and Medical terminology
• Ability to apply analytical and critical thinking in medical records reviews
• Knowledge in CMS Medicare and Medicaid guidelines.
• Good verbal / written communication skills.
• Ability to use a computer, facsimile and copy machine.
• Intermediate Microsoft Office skills (Excel, Word, Outlook).
• During your first 6 months of employment, you must complete 100 hours of specified
revenue cycle education including HBS’ Revenue Cycle Library I, Revenue Cycle Library II
and Revenue Cycle Library III. Employees promoted from a CDRS I position will have fulfilled
this requirement prior to promotion to a CDRS II.