The Certified Coding Specialist (CCS) is responsible for accurate and compliant coding, charge capture review, claims support, and documentation validation for behavioral health services within a Certified Community Behavioral Health Clinic (CCBHC). This position ensures adherence to federal, state, Medicaid, Medicare, and commercial payer guidelines while supporting revenue integrity and compliance initiatives.
The Coding Specialist works collaboratively with providers, billing staff, compliance personnel, and clinical leadership to improve coding accuracy, reduce denials, and support optimal reimbursement for behavioral health and integrated care services.
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The primary responsibility of all staff is to ensure the safety and well-being of all Ramey-Estep/Re-group (RE) clients.
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Supports the mission, vision, and values of RE. Facilitates and adheres to the agency’s code of ethics, policies, and procedures.
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Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
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Supports and facilitates positive interaction with clients and staff by exhibiting both in-office and in-public when carrying out job duties: individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and awareness and sensitivity to cultural and other differences in clients and staff.
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Exhibits effective communication skills including proper use of agency communication systems.
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Participates in appropriate professional development programs to attain and maintain competency.
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Effectively manages financial and physical resources to achieve the mission of RE.
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Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE.
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Review and assign accurate ICD-10-CM, CPT, HCPCS, and modifiers for behavioral health, substance use disorder, and integrated care services.
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Ensure coding compliance with CCBHC standards, CMS regulations, Medicaid requirements, and payer-specific billing guidelines.
- Conduct routine audits of clinical documentation to ensure coding accuracy and medical necessity.
- Identify coding discrepancies, documentation deficiencies, and potential compliance risks.
- Collaborate with providers and clinical staff to improve documentation practices and coding specificity.
- Assist with denial management and appeals related to coding issues.
- Monitor regulatory updates and communicate coding changes impacting behavioral health services.
- Maintain confidentiality and security of protected health information in accordance with HIPAA regulations.
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Support internal and external audits as requested.
- Participate in quality improvement and compliance initiatives.
- Prepare coding reports and productivity metrics for leadership review.
- Provide coding education and guidance to providers and staff.
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Performs other duties as assigned.
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Shift is generally day shift, Monday - Friday.
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Holidays, weekends, and extra hours may occasionally be required.
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Office setting with extensive computer usage.
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May require occasional travel for training or meetings.
High School Diploma or GED required.
Associate Degree in Business or Medical Billing and Coding field preferred; work experience or other education may be considered in lieu of degree.
Minimum of two (2) years of supervisory or lead experience in medical coding, billing, or health information management required.
Experience with electronic health record (EHR) systems and revenue cycle platforms is required.
Minimum of three (4) years of coding experience in behavioral health, mental health, substance use treatment, or healthcare setting preferred.
Experience working in a CCBHC, FQHC, CMHC, or integrated behavioral health setting preferred.
Must be at least 21 years of age.
Excellent organizational, analytical, and communication skills.
Strong knowledge of ICD-10, CPT, HCPCS, Medicaid, Medicare, and behavioral health billing requirements.
Knowledge of SAMHSA CCBHC requirements and documentation standards.
Technical requirements include proficiency with Microsoft Word, Excel, PowerPoint, and any other applications used by the organization or regulatory agencies.
Must also have ability to interface well with all departments in a highly professional manner.
Ability to understand and relate to the needs of clients from diverse backgrounds.
Ability to read, write and converse in English.
Successful completion of a pre-employment drug screen.
Successful completion of a background screening.
Successful completion of a TB skin test or proof of a negative chest x-ray or other documentation.
Certified Coding Specialist (CCS), CPC, or equivalent coding certification required.
Certified Professional Medical Auditor (CPMA), Certified Coding Auditor (CCA), or equivalent auditing certification preferred.
Successful completion of Excellent Foundations
Maintain 20 hours of annual training
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to stand, sit, walk, talk, hear, reach with hands and arms, and use hands to finger, handle, and feel. This employee is also regularly required to use a computer keyboard and mouse. The employee is occasionally required to stoop, kneel, crouch, and climb stairs. The employee must occasionally lift and/or move up to 10 pounds or more. Specific vision abilities required by this job include close vision, distance vision, and peripheral vision.
