About the Role:

As a Senior Coding Specialist, you will play a crucial role in ensuring accurate and compliant coding of medical procedures and diagnoses for reimbursement purposes. You will utilize your extensive knowledge of medical coding guidelines, regulations, and industry standards to review and assign appropriate diagnostic and procedural codes. This role requires a high level of attention to detail, proficiency in coding systems, and the ability to collaborate effectively with healthcare providers and coding team members.

Essential Job Responsibilities:

• Medical Coding: Assign accurate ICD-10-CM, CPT, HCPCS, and other applicable medical codes to diagnoses, procedures, and services performed by healthcare providers based on medical record documentation.
• Review and Analysis: Conduct comprehensive reviews of medical records, encounter forms, and other clinical documentation to ensure completeness, accuracy, and compliance with coding guidelines and regulatory requirements.
• Documentation Improvement: Collaborate with physicians, clinicians, and other healthcare professionals to clarify documentation inconsistencies, resolve coding-related queries, and facilitate accurate code assignment.
• Coding Compliance: Adhere to coding conventions, official coding guidelines, regulatory requirements (e.g., CMS, HIPAA), and organizational policies and procedures to ensure coding accuracy and compliance with reimbursement guidelines.
• Audit and Quality Assurance: Participate in coding audits and quality assurance activities to evaluate coding accuracy, identify coding errors or discrepancies, and implement corrective actions as needed.
• Education and Training: Provide training and education to coding staff, healthcare providers, and other stakeholders on coding principles, updates, and best practices to promote coding accuracy and compliance.
• Coding System Maintenance: Stay current with changes in coding systems, reimbursement methodologies, and healthcare regulations, and update coding software and reference materials accordingly.
• Reporting and Documentation: Maintain accurate records, reports, and documentation of coding activities, audit findings, and compliance initiatives, ensuring confidentiality and data integrity.
• Workflow Optimization: Identify opportunities for process improvement, efficiency enhancement, and automation in coding workflows to streamline operations and enhance productivity.
Team Collaboration: Collaborate with other coding specialists, billing staff, revenue cycle management teams, and healthcare providers to support revenue cycle integrity and optimize reimbursement outcomes.

Qualifications:

• CIRCC Certification required; Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credential preferred.
• Experience in medical coding, with a focus on inpatient, outpatient, or professional fee coding in a healthcare setting.
• Proficiency in ICD-10-CM/PCS, CPT, HCPCS Level II coding systems, as well as knowledge of medical terminology, anatomy, physiology, and disease processes.
• Strong understanding of coding guidelines, regulations (e.g., CMS, OIG), reimbursement methodologies, and healthcare compliance requirements.
• Excellent analytical and problem-solving skills, with the ability to interpret complex medical documentation and apply coding principles accurately and efficiently.
• Effective communication and interpersonal skills, with the ability to interact professionally with healthcare providers, coding team members, and other stakeholders.
• Detail-oriented with a high level of accuracy and attention to detail in coding assignments and documentation review.
• Proficiency in coding software, electronic health record (EHR) systems, and Microsoft Office applications.
• Commitment to continuous learning, professional development, and staying abreast of industry changes and updates in medical coding practices.