General Position Summary:
The Medical Coding Specialist works as part of the Billing & Coding Department to review clinical documentation, abstract data from patient medical records, and accurately assign diagnosis and procedure codes in accordance with applicable coding guidelines and regulatory requirements.
Essential Duties and Responsibilities:
- Reviews patient medical records and assigns diagnosis and procedure codes in accordance with ICD-10-CM, CPT, HCPCS, and applicable coding guidelines.
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Ensure compliance with federal, state, payer, and organizational coding regulations and policies.
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Assigns and sequences diagnosis and procedure codes accurately for all services rendered.
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Ensures documentation and coding accurately reflect services provided and support quality reporting metrics.
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Identifies missed diagnoses, chronic conditions, and documentation deficiencies that may impact quality scores, reimbursement, and patient outcomes.
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Collaborate with providers to clarify documentation and obtain additional information when necessary to support accurate code assignment.
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Abstracts pertinent clinical and demographic data from the medical record.
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Maintains a working knowledge of applicable payer methodologies, reimbursement guidelines, and coding requirements.
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Determines whether medical necessity is supported within the patient record based on clinical documentation and payer guidelines.
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Ensures all diagnosis and procedure codes utilized are current, valid, and active.
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Communicates missing, incomplete, or inconsistent documentation to providers for clarification and correction.
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Performs regular chart audits and coding reviews to ensure documentation accuracy, coding compliance, and data integrity.
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Provides education and training to providers and clinical staff to improve documentation quality and coding accuracy.
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Collaborates with clinical and administrative departments to optimize workflows and ensure timely completion and locking of medical records.
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Maintains the confidentiality of all patients, provider, and organizational information in accordance with HIPAA and organizational policies.
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Reviews and captures Risk Adjustment/HCC diagnoses in accordance with CMS guidelines.
- Monitors coding-related quality measures, including HEDIS and other value-based care initiatives.
- Assists with payer audits, compliance reviews, and responses to coding inquiries.
- Maintains coding certification and participates in ongoing professional development and continuing education.
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Demonstrates effective internal and external customer service skills.
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Maintains regular and reliable attendance, as physical presence may be required to perform the essential functions of the position.
Performs other duties as assigned.
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Other Functions:
- Staff will abide by the Code of Conduct as documented in the Corporate Compliance Manual.
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Must demonstrate a personal and professional commitment to Johnson Health Center (JHC) and its mission.
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Treats all patients and staff with dignity and respect, mindful of the cultural differences of the diverse population we serve.
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Management may modify, add, or remove any job functions as necessary, or as changing organizational needs require.
JHC Core Values:
Staff members must actively demonstrate dedication and commitment to the core values of JHC.
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Respect – We value and respect each patient, their family, ourselves, and each other.
Every individual associated with Johnson Health Center will be treated with dignity and respect. We value and respect people’s differences, show empathy to our patients, their families and each other, and work collectively to build Johnson Health Center as a health center and an employer of choice.
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Integrity – We are committed to doing the right thing every time.
Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical behavior. We are accountable for the decisions we make and the outcome of those decisions.
- Excellence – We will pursue excellence each and every day in activities that foster, teamwork, quality improvement, patient care, innovation, and efficiencies.
At Johnson Health Center, our medical, dental, pharmacy, behavioral health, front desk and administrative teams are passionately committed to the highest quality of care for our patients. We continually seek out ways to enhance the patient experience and promote an environment of continuous quality improvement.
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Innovation – We value creativity, flexibility, and continuous improvement efforts.
We are advocates and instruments of positive change, encouraging employees to engage in responsible risk-taking and working to make a difference. Out of the box thinking enables us to build on successes and learn from failures.
- Teamwork – We understand that teamwork is the essence of our ability to succeed.
We work across functional boundaries for the good of the organization. Our collaborative approach ensures participation, learning and respect and serves to improve the quality of patient care. By focusing on a team-based approach, the expertise of each Johnson Health Center employee is leveraged to optimize the patient experience.
Qualifications:
- High school diploma or equivalent required. Current Certified Professional Coder (CPC), Certified Coding Specialist (CCS), is required.
- Minimum of two (2) years of medical coding experience required; experience in physician practice, outpatient, primary care, or value-based care settings preferred.
- Demonstrated knowledge of ICD-10-CM, CPT, HCPCS, medical terminology, anatomy and physiology, and payer-specific coding guidelines.
- Proficient in the use of electronic health records (EHRs), practice management systems, and Microsoft Office applications, including Word, Excel, and Outlook.
- Strong analytical, organizational, and problem-solving skills with a high degree of accuracy and attention to detail.
- Excellent written and verbal communication skills with the ability to effectively collaborate with providers, clinical staff, and external organizations.
- Ability to work independently, prioritize multiple tasks, and meet established productivity and quality standards.
Knowledge of risk adjustment/HCC coding, quality measures, and documentation improvement processes preferred.
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Physical Demand and Working Environment:
Fast-paced office setting with travel to other offices often. Lifting and/or exerting force up to 15 pounds occasionally, with frequently moving of objects. Work requires speaking, sitting, bending, walking, standing, hearing, and stooping, kneeling, and repetitive motion with certain activities. 8-10 hours of constant computer usage. OSHA low-risk position.
