MEDICAL CODING SPECIALIST

Job Title: Medical Coding Specialist

Responsible for correctly coding healthcare claims, in order to obtain reimbursement from insurance companies and government health care programs.

Service Standards

FCHC Core

• Demonstrates a commitment to FCHC mission and vision.
• Demonstrates a positive attitude towards patients, employees, role, and the health center.
• Demonstrates FCHC core values (accountability, courtesy, excellence, flexibility, integrity, respect).

Customer Service and Professionalism

• Smiles and makes appropriate contact, greets individuals upon entry into building and space.
• Is customer service oriented to both internal (colleagues) and external (patients, clients, vendors, etc.).
• Treats patients, customers and colleagues with dignity and respect.
• Provides timely response to requests, tasks, and inquiries. Demonstrates good service turnaround.
• Demonstrates good communication skills and communicates in a tactful manner.
• Exhibits conflict resolution skills to foster effective working relationships and embraces a team approach.
• Adheres to FCHC’s dress code policies. Employee appearance and grooming appropriate.

Show(s)

• Consistently shows commitment to position and team performance (attendance and punctuality).
• Considers and accepts cultural differences of others; works well with individuals from diverse backgrounds, supporting a culture of justice, equity, diversity, and inclusion.
• Participates in training and professional development and completes required trainings in a timely manner.

Safety

• Adheres to and promotes a culture of safety and cleanliness.
• Adheres to HIPAA/Confidentiality standards.
• Is respectful of FCHC property and uses Health Center Equipment safely.

Intradepartmental Relationships

• Chief Financial Officer, Providers, Patient Account Specialists, Senior Accountant

Primary Responsibilities

• Analyzes provider documentation carefully to determine diagnosis and assigns every item with specific codes.
• Assigns codes for diagnosis, treatments and procedures according to the appropriate classification system.
• Reviews claims data to ensure assigned codes meet required legal and insurance rules and that required authorizations are in place prior to submission.
• Evaluates and re-files appeals for patient claims that were denied.
• Ensures correct patient allocation is set.
• Voids any duplicate charges or charges entered in error.
• Identifies and reports error patterns.
• Notifies coding supervisors of missing orders or documentation clarification.
• Ensures timely and efficient billing of all electronic claims submissions.
• Accurately enters payment and adjustments in the A/R system.
• Collects health information as documented by medical providers and codes it appropriately.
• Consults medical providers for further clarification and understanding of items on patient charts to avoid any misinterpretations.
• Provides accurate account information to patients about their A/R accounts and makes any necessary corrections.
• Complies with HIPAA, federal regulations, and Family Care Health Centers policies.

Periodic Duties

• Contributes to Health Center community health activities outside of regular job responsibilities.
• Participates in Health Center staff problem solving groups.
• Attends and participates in department meetings, etc. as assigned.
• Performs other duties as assigned.

Working Relationships

Outside Health Center

• Accountants at other community health centers, etc.

Qualifications

• High School Diploma or GED Certificate required.
• Associate Degree or Certificate in Medical Coding, health information technology or related field preferred.
• Certified Professional Coder (CPC) required.
• Coding certification from AHIMA or AAPC preferred.
• Two plus (2+ years) of medical coding experience and/or training or the equivalent combination of education and experience preferred.

Confidentiality

Respect for and maintenance of client and staff confidentiality is required.