Major Responsibilities:

• Responsible for completing all certified coder quality reviews. Working in collaboration with coding leads and supervisors.
• Develops and maintains monitoring tools for the evaluation of coding quality standards. Provides training and support in utilizing coding quality tools.
• Develops and maintains coding quality standardized reporting mechanisms. Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties.
• Identifies and trends coding quality issues/concerns. Recommends coding accuracy improvement strategies, including continued education and/or training plans. Provides feedback regarding coding guidelines, coding protocols/procedures and system edits to continually improve coding processes and ultimately the overall coding quality program.
• Conducts scheduled and ad hoc coding quality reviews. Provides results to Physician Coding leadership and education recommendations as needed. Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations.
• Reviews abstracted and coded encounters for coding accuracy and completeness. Provides feedback on billing system edits as applicable. Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

• Typically requires 5 years of experience in expert-level professional coding experience and at least 3 years of experience in education/training of licensed clinicians.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD-10-CM, CPT and HCPCS coding guidelines.
• Advanced knowledge of medical terminology, anatomy and physiology.
• Advanced ability to identify coding quality issues/concerns and provide recommendations for improvement.
• Advanced ability to analyze trends and data and display in a statistical reporting format.
• Advanced analytical skills, with a high attention to detail.
• Intermediate computer skills including experience in using Microsoft Office or similar products and email.
• Advanced organization and communication (verbal and written) skills.
• Advanced ability to effectively train others through oral and/or written methods.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.
• E/M experience desired

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

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This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.