Position Summary:
The Coding Specialist position translates medical documentation into standardized codes for billing, claim processing, and data analysis. This position is a senior level, mentoring position for other coders and requires individuals with significant experience and a high level of coding proficiency. This position requires the ability to analyze operative reports and assign surgical codes according to coding guidelines and payer requirements.
Key Responsibilities:
- Documentation Review: Analyze and interpret clinical documentation to ensure completeness and accuracy for coding purposes.
- Assign Codes: Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services based on clinical documentation and official coding guidelines.
- Validate Codes: Verify and correct codes recommend by Computer-Assisted Coding (CAC) software.
- Utilize Coding Guidelines: Research and utilize all current coding guidelines for appropriate code assignment; including but not limited to AHA Coding Clinic, CPT Assistant, federal regulations, CCI coding initiatives, Official Guidelines for ICD-10 and CPT, insurance payer guidelines and Trinity Health internal coding guidelines.
- Collaboration: Work with healthcare providers/team to clarify inadequate, ambiguous, or unclear documentation to resolve coding discrepancies.
- Workflow and Processes: Follow established workflows and processes to ensure efficiency and productivity.
- Coding Claim Edits: Review, resolve, and process coding claim edits to ensure clean claim submission.
- Productivity: Maintain acceptable productivity rate according to established coding benchmarks based on type of work.
- Quality: Maintain acceptable quality rate at 95% or higher.
- Confidentiality: Ensure strict confidentiality of healthcare and financial records by following Trinity Health policies related to Compliance, Privacy and Security.
- Teamwork: Engage as a team player and assist others as needed.
Licenses and Certifications Required:
- An applicable credential from one of the following associations is required upon hire:
- American Health Information Management Association, including CCA, CCS, CCS-P, RHIT, or RHIA; or
American Association of Professional Coders, including CPC-A, CPC, COC, or CIC.
Educational Requirements:
- AHIMA or AAPC certification required.
Experience Requirements:
- Medical coding coursework or training applicable to the position.
- Minimum of 8 years of coding experience.
- Prior experience includes (facility or professional) INP, ETC, SDS, OBS.
Special Skills or Training Requirements:
- Knowledge of ICD-10, CPT, and HCPCS coding and interpreting/applying coding guidelines.
- Strong understanding of medical terminology, anatomy, and physiology.
- Proficiency with computers.
- Ability to use electronic health record systems, coding software, billing software, and other relevant computer programs.
- Strong attention to detail.
- Strong communication skills.
- Problem-solving capabilities.
- Ability to work independently.
- Effective time-management skills.
- Self-motivated.
Physical Requirements:
This position requires extended periods of sitting and continuous use of a computer, keyboard, and mouse to review documentation, assign codes, and enter data. Work involves repetitive hand motions and sustained visual focus while analyzing detailed clinical information. Occasional movement, such as standing or stretching, may be needed throughout the day to maintain comfort and focus.
Environmental Requirements:
The role is performed in an office or remote setting where reliable technology, secure systems access, and strict adherence to confidentiality standards are essential. Work involves frequent electronic communication with team members, supervisors, and other departments. A quiet, organized environment is necessary to support concentration and ensure the accuracy required for complex coding tasks, while compliance with HIPAA and all organizational privacy standards must be maintained at all times.