Under established coding principles and procedures reviews, analyzes, and validates the diagnostic and/or procedural codes applied from front-end coding and clinical teams for reimbursement and billing purposes. The CBO Coding Complex Specialist accurately abstracts information from the electronic health record for compilation of a patient database, which supports medical research projects, patient care evaluation and administrative decision making related to patient care. The coding function is considered a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, and regulation and accreditation guidelines.
- High school diploma or G.E.D. equivalent required.
- Minimum of two (2) years coding experience required. Additional specialty coding certification or 10 years coding experience required.
- Prior experience in a healthcare revenue cycle position required.
- Specialty coding experience preferred.
- One to two (1-2) years college or additional course work in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.
- Must have through knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems.
- Strong organizational and time management skills required to effectively prioritize work.
- Ability to communicate effectively with colleagues, supervisor, and manager.
- Ability to work independently.
- Ability to work remotely.
- Proficient in medical terminology.
- Proficient in ICD-10 CM, CPT and HCPCS coding.
- Able to recognize patterns and trends and escalate to supervisors to support root-cause analysis.
- Able to assist other team members.
- Supports the standards set forth in the HFHS Code of Conduct by adhering to legal and ethical guidelines.
- Certification as a Registered Health Information Technician (RHIT), CPC, or CCS certification required.