Clinical Coding Specialist Job Description
Clinical coding specialist
provides ongoing formal and informal education to the medical staff regarding coding documentation rules and regulations, HCC coding and reimbursement guidelines.
Clinical Coding Specialist Duties & Responsibilities
To write an effective clinical coding specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included clinical coding specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
In collaboration with Certified Coding Manager, Coding Specialists, and PACE Clinicians, identifies areas of educational need
Assures that accurate, complete client care documentation is completed timely, in preparation for billing (RAPS, charge tickets, etc)
Keeps current in area of expertise and assures that standards and practices within the site reflect best practice in coding and LifePlan accuracy
Coordinate with practices to have applicable claims resubmitted with proper diagnoses and / or educate the providers to ensure future claims are coding completely and accurately
Validates HCPCS and revenue codes related to routine Change Description Master (CDM) maintenance, during annual coding changes and for system wide departmental CDM reviews
Reviews claim data related to non specific implant charges and assigns more specific codes, as appropriate
Conducts departmental CDM reviews and provides clinical assessment of services to identify HCPCS necessary for appropriate charge capture
Provides educational in-services to PFS and health system coding staff
Monitors regulatory guidelines and initiates CDM changes, as required
Reviews OCE report and analyzes claim data related to edits
Clinical Coding Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Clinical Coding Specialist
List any licenses or certifications required by the position: AHIMA, ICD, CDIP, CCDS, ACDIS, CIRCC, CCS
Education for Clinical Coding Specialist
Typically a job would require a certain level of education.
Employers hiring for the clinical coding specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Health Information Management, Education, Associates, Health, Healthcare, Medical, Nursing, Medical Terminology, Physiology, Anatomy
Skills for Clinical Coding Specialist
Desired skills for clinical coding specialist include:
Medical terminology
Excel
Anatomy and physiology
Coding and application
Compliance with federal regulations
Hospital information systems and encoders
Research
Coding principles to determine potential coding issues and quality concerns
MedDRA and WHO Drug coding practices
Changes in coding and reimbursement guidelines and regulations
Desired experience for clinical coding specialist includes:
Clinical documentation and coding improvement efforts for surgical coders with experience in cardiology, cardiothoracic surgery, orthopedics and other surgical areas preferred
Coding for critical care and hospital pediatrics preferred
CCS certification required, additional CCS-P or RHIT preferred
Minimum of 1 year coding experience
All candidates must successfully pass an ICD-10-CM and CPT-4 coding exam
Assists in preparation of responses related Medicare output claim denials
Clinical Coding Specialist Examples
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Clinical Coding Specialist Job Description
Job Description Example
Our company is growing rapidly and is looking for a clinical coding specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for clinical coding specialist
- Using the clinical coding tools and other established SCHARP guidelines, select the clinical code most closely aligned with the adverse event being reported
- Coordinate the collection and entry of study site-specific laboratory reference ranges
- Responsible for presenting chart audit findings physician performance trends to management
- Uses performance improvement methodologies and education strategies to develop formal training and improvement programs for staff concerning clinical documentation opportunities, coding and reimbursement issues
- Performs comprehensive chart reviews to ensure documentation required to facilitate the reporting of HCC diagnoses to payer
- Identifies claims correction opportunities and submits to appropriate personnel for processing
- Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patient's chart note
- Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures
- Partners with QCDI Nurse, as necessary, to identify trends and gaps for creating better process efficiency and provider performance
- Assists in the development and reporting of HCC and Pay for Performance Metrics
Qualifications for clinical coding specialist
- Certified Professional Coder (CPC) through the American Academy of Professional Coders or equivalent certification is required
- Certified Coding Specialist (CCS), preferred
- Minimum of two (2) years progressively responsible experience including familiarity with ICD-9 coding and HCPCS coding for outpatient hospital billing, required
- Prior clinical nursing experience and chart review, required
- Maintains current knowledge of federal and state requirements related to HCPCS coding and hospital billing and reimbursement
- BA/BS degree with medical record science or related field desired
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Clinical Coding Specialist Job Description
Job Description Example
Our company is looking for a clinical coding specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for clinical coding specialist
- Provides structured and ad hoc training/education to staff and providers
- Performs necessary analysis of data for the purpose of identifying trends and making suggestions for change to process
- Facilitates and participates in regular meetings with Health Information Management (HIM), Care Management, and other staff to develop and implement strategies for improvement of clinical documentation and financial outcomes
- Works collaboratively with Coding staff to ensure appropriate DRG assignment and that reimbursement reflects the level of services rendered
- Matrix relationship to Revenue Operations & Coding, Supervisor and IR, Associate Director
- Split time and shared oversight with IR
- CIRCC certification through the American Academy of Professional coders
- Training and quality oversight of the IR technologist
- Routine quality review reports
- Your primary responsibility will be to oversee the coding of medical terms from clinical trials and drug safety reports to standard Medical or Drug Dictionary terminology
Qualifications for clinical coding specialist
- Minimum of one (1) to three (3) years of experience working in a physician practice or in a billing service supporting the coding and billing functions of a physician practice required
- Minimum of two years of clinical coding experience required
- At least 5 years of experience in quality improvement and/or inpatient clinical documentation improvement, with knowledge of ICD-10 chart abstraction methodology
- Bachelor’s degree in a clinical field
- Four (4) years of experience utilizing ICD-9-CM, ICD-10, CPT, HCPCS coding systems respective reimbursement methodologies associated with each coding system required
- Demonstrated experience reviewing health care delivery against clinical, quality, financial established guidelines
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Clinical Coding Specialist Job Description
Job Description Example
Our growing company is looking for a clinical coding specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for clinical coding specialist
- This role will allow you to establish and maintain relationships with clinical study teams to discuss coded data handling processes and coding-related issues
- Setting targeted timeframes for deliverables and anticipating potential scenarios that may delay timelines
- Follows most recent documentation and coding guidelines
- Queries providers on specificity of coding whenever there is any question and clarifies all
- Train physicians, physician assistants and employees for MRA coding opportunities
- Ensure that codes assigned meet medical necessity requirements by Medicare and other carriers
- Creates and assists with the maintenance of Chronic Condition Lists for all PCPs
- Maintains an electronic database with the results of all medical chart reviews performed
- Assists with the analysis and action planning in response to findings of the utilization practices in the office
- Assists in the care coordination duties as necessary in specific patient populations and works with Case Management to procure services for those identified patients
Qualifications for clinical coding specialist
- Bachelors Degree (or higher) or High School Diploma / GED with experience in Clinical References
- Demonstrated analytical & critical thinking skills.Ability to ensure that clinical/claims data reporting is in compliance with requested data set
- Autonomous/Independent worker, minimal supervision, including process management skills.Demonstrated subject matter expert in all coding systems
- Demonstrated project management skills and proficiency with project management software
- Demonstrated ability to serve as effective team member of cross-functional teams and/or proven ability to facilitate teams
- Demonstrated understanding of organizational business strategies audit and reimbursement related business strategies
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Clinical Coding Specialist Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of clinical coding specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for clinical coding specialist
- Is responsive to anyone who has questions regarding this area of expertise
- Performs all other coding and documentation reviews and/or projects as asked and assists/coordinates strategies as defined by the department head or assistant
- Create and monitor rule lists and rule attributes
- Participate in project launch through attendance of meetings and assist with the development of rule strategy
- Perform quality review of lists prior to development of algorithms
- Attend project team meetings and Investigator's meetings as requested
- Develop and maintain a working knowledge of assigned projects
- Receive, fulfill and track medical information inquiries for marketed products
- Receive, document and track adverse event / product complaint telephone reports for marketed products
- Ensure compliance with company policies, procedures and standard
Qualifications for clinical coding specialist
- Demonstrated organizational skills, verbal & written communication skills with ability to effectively communicate with personnel and providers externally
- Knowledge of facility contract reimbursement policies
- Minimum of two years of clinical coding experience required utilizing the MedDRA and WHO-DD Coding tools
- Identify clinical indicators to ensure diagnosis and procedures are clinically supported
- Ensure each treated diagnosis is documented in the medical record to the appropriate specificity in collaboration with providers, and coders aimed at ensuring accurate, complete,and compliant medical records which relect the severity and complexity of a patient's illness
- RN License or HIM Degree Required
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Clinical Coding Specialist Job Description
Job Description Example
Our growing company is hiring for a clinical coding specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for clinical coding specialist
- Participate in the process of developing and review of SOPs
- Interact with other Optum functions, such as project management, data management, to ensure the highest level of client satisfaction through successful execution of projects
- Maintain a high level of expertise with client projects and marketplace developments through participation in internal meetings, including project tracking, and attendance at professional seminars and workshops
- Manages queries related to coding terms, through closure
- Identify MedDRA and WHO-DD coding synonyms
- On request, assist other member of the Clinical Coding and Safety staff or external partners with information from the MedDRA and WHO-DD Coding tools
- Review the coded data of junior staff to ensure coding is both correct and codes are applied consistently across all studies in accordance with established work instructions
- Assists study teams in tasks related to coding to ensure that databases can be declared clean and locked according to strict quality standards
- Participate on SCHARP working groups, special projects, and attend network meetings or study meetings as needed
- May contribute to the development, review and implementation of SOPs, templates and processes and other departmental and/or cross functional initiatives
Qualifications for clinical coding specialist
- RHIT, RHIA, CCS, or CCDS Required
- Excellent verbal and written communication skills.Ability to communicate in a clear and concise manner with physicians and staff to ensure accurate documentation in the medical record
- Requires critical/analytical thinking and problem solving skills in evaluating the clinical documentation
- Ability to effectively present information and respond to inquiries or complaints from physicians and ancillary staff in a positive, professional interpersonal manner
- Excellent knowledge of HCCs and diagnostic criteria
- Must be able to travel to various NWPHO offices