Responsible for coding and abstracting patients’ records for professional billing.
Reviews patient medical records retrospectively and concurrently for the coding and sequencing of diagnoses and procedures for reimbursement purposes.
Interacts and assists with coding requests and questions from billers.
Serves as a resource for difficult coding questions and assists with insurance denials for correction and re-filing.
Makes process improvement recommendations to management as identified, specifically related to registration and charge posting.
Performs in compliance with federal, state, insurance industry regulations.
Follows established hospital policies concerning corporate compliance.
Keeps abreast of insurance carrier rules and changes by participating in carrier specific and MCI education opportunities.

High school diploma or GED required.
One to two years post high school education preferred.
A minimum of two years current experience with ICDM 9, CPT coding, and health insurance provider rules and regulations required.
Coding Certification required.
Knowledge of anatomy and physiology and medical terminology required.
Proof of completion of Mandatory Reporter abuse training specific to population served within three (3) months of hire.
Knowledge of physician EM coding desired.
Working knowledge of computer information systems required.
Demonstrates professional, appropriate, effective and tactful written, verbal, and nonverbal communication with patient, families, medical staff, colleagues, vendors, and other departments throughout the continuum of care to promote continuity of care and services and enhance department image.
Must be a self-starter and able to work independently and make appropriate decisions within hospital and departmental guidelines with little assistance from Manager.

Coding Certification required
Minimum of two years current experience with ICDM 9, CPT coding, and health insurance provider rules and regulations required.

Auditor Coding Specialist

Key skills