Medical Coding Specialist

Medical Coding Specialist

Description

Under general supervision the Medical Coding Specialist reviews analyzes and validates provider documentation to ensure accurate complete and compliant coding of diagnoses and procedures. This role supports timely and appropriate reimbursement by assigning correct ICD-10-CM CPT and HCPCS Level II codes for professional services in both office and hospital settings. The position also serves as a coding resource for providers offering education and guidance to support accurate documentation within the Electronic Health Record (EHR).

Essential Duties & Responsibilities

• Reviews and codes professional services for office and hospital encounters in accordance with official coding guidelines and payer requirements.

• Audits medical records prior to billing to ensure documentation supports reported diagnoses procedures and Evaluation & Management (E/M) levels.

• Applies accurate ICD-10-CM diagnosis codes CPT procedure codes and HCPCS Level II codes for all services rendered.

• Analyzes provider documentation to ensure correct assignment of E/M levels using current CMS and AMA guidelines.

• Performs quantitative record analysis to ensure completeness including patient identifiers required signatures dates and supporting documentation.

• Performs qualitative record analysis to assess documentation consistency clarity and adequacy relative to services billed.

• Ensures coding and documentation compliance with federal and state regulations CMS guidelines and payer-specific rules.

• Identifies coding trends errors or opportunities for improvement and communicates findings to leadership and providers.

• Provides education feedback and training to providers and staff on documentation and coding best practices.

• Collaborates with billing compliance and clinical teams to resolve coding-related issues and denials.

• Maintains required productivity accuracy and quality standards.

• Attends continuing education seminars and in-services to remain current with coding changes and regulatory updates.

• Maintains compliance with organizational policies compliance program standards and the Code of Conduct.

• Performs other related duties as assigned.

Education & Qualifications

• High School Diploma or equivalent required.

• Active professional coding certification required (CPC CCS RHIT or RHIA).

• Minimum of 2 years of professional medical coding experience preferred (OB/GYN experience strongly preferred).

• Demonstrated proficiency with ICD-10-CM CPT and HCPCS Level II coding systems.

• Experience with EHR and practice management/billing systems.

• Strong computer skills including Microsoft Office applications.

Knowledge Skills & Abilities

• Thorough knowledge of official coding guidelines and conventions established by AMA CMS and AHA.

• Working knowledge of federal and state regulations impacting coding billing and reimbursement.

• Understanding of professional fee billing and common payer requirements.

• Strong analytical skills with attention to detail and accuracy.

• Ability to interpret clinical documentation and apply appropriate codes independently.

• Excellent written and verbal communication skills including the ability to educate providers diplomatically.

• Strong organizational and time-management skills with the ability to meet deadlines.

• Ability to handle sensitive and confidential information in accordance with HIPAA.

Responsibility Skills & Difficulty of Work

• Performs complex coding and auditing work requiring independent judgment and a high degree of accuracy.

• Reviews identifies and resolves coding discrepancies through audits and education.

• Communicates clearly and professionally with providers staff and external partners.

• Maintains confidentiality and compliance at all times.

• Works independently with minimal supervision while contributing to overall team goals.

• Adheres to all organizational policies and procedures.

Personal & Work Relationships

• Maintains strict HIPAA confidentiality standards.

• Works collaboratively with providers leadership billing staff vendors and the public to exchange factual information.

• Plans and prioritizes work to ensure timely completion within established productivity expectations.

• Demonstrates professionalism teamwork and accountability in all interactions.