Description

BASIC FUNCTION:

JOB DESCRIPTION

DEPARTMENT: Finance

JOB TITLE:

MEDICAL CODING SPECIALIST

Responsible for correctly coding healthcare claims, in order to obtain reimbursement from insurance companies and government

health care programs.

All employees of FCHC must ensure service standards are delivered, including:

FCHC Core

• Demonstrates a commitment to FCHC mission and vision.

• Demonstrates a positive attitude towards patients, employees, role, and the health center.

• Demonstrates FCHC core values (accountability, courtesy, excellence, flexibility, integrity, respect).

Customer Service and Professionalism

• Smiles and makes appropriate contact, greets individuals upon entry into building and space.

• Is customer service oriented to both internal (colleagues) and external (patients, clients, vendors, etc.)

Customers. Treats patients, customers and colleagues with dignity and respect.

• Provides timely response to requests, tasks, and inquiries. Demonstrates good service turnaround.

• Demonstrates good communication skills and communicates in a tactful manner.

• Exhibits conflict resolution skills in order to foster effective working relationships and embraces a team

approach.

• Adheres to FCHC’s dress code policies. Employee appearance and grooming appropriate.

Show(s)

• Consistently shows commitment to position and team performance (i.e., attendance and punctuality).

• Consideration and acceptance of cultural differences of others; works well with individuals of diverse

backgrounds, supporting a culture of justice, equity, diversity, and inclusion.

• Participates in training and professional development and completes required trainings in a timely manner.

Safety

• Adheres to and promotes a culture of safety and cleanliness.

• Adheres to HIPPA/Confidentiality standards.

• Respectful of FCHC property, properly and safely uses Health Center Equipment.

INTRADEPARTMENTAL RELATIONSHIPS:

Works Closely With:

Chief Financial Officer

Chief Financial Officer, Providers, Patient Account Specialists, Senior Accountant

MEDICAL CODING SPECIALIST

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PRIMARY RESPONSIBILITIES:

Analyzes provider documentation carefully to know the diagnosis and assigns every item with specific codes.

Assigns codes for diagnosis, treatments and procedures according to the appropriate classification system.

Reviews claims data to ensure assigned codes meet required legal and insurance rules and that required

authorizations are in place prior to submission.

Evaluates and re-files appeals for patient claims that were denied.

Ensures correct patient allocation is set.

Voids any duplicate charges or charges entered in error.

Identifies and reports error patterns.

Notifies coding supervisors of missing orders or documentation clarification.

Ensures timely and efficient billing of all electronic claims submission.

Accurately enters payment and adjustments in the A/R system.

Collects health information as documented by medical providers and codes them appropriately.

Consults medical providers for further clarification and understanding of items on patient charts to avoid any

misinterpretations.

Provides accurate account information to patients about their A/R accounts and makes any necessary

corrections.

Complies with HIPPA, federal regulations, and Family Care Health Centers policies.

PERIODIC DUTIES:

Contributes to Health Center community health activities outside of regular job responsibilities.

Participates in Health Center staff problem solving groups.

Attends and participates in department meetings, etc. as assigned.

Performs other duties as assigned.

MEDICAL CODING SPECIALIST

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WORKING RELATIONSHIPS:

Inside Health Center:

All inclusive.

Outside Health Center: Accountants at other community health centers, etc.

QUALIFICATIONS:

High School Diploma or GED Certificate required.

Associate Degree or Certificate in Medical Coding, health information technology or related field preferred.

Certified Professional Coder (CPC) required.

Coding certification from AHIMA or AAPC preferred.

Two plus (2+ years of medical coding experience and/or training or the equivalent combination of education

and experience preferred.

CONFIDENTIALITY:

Respect for and maintenance of client and staff confidentiality is required.

The above responsibilities/duties describe the chief function (requirements) of the job (ho

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