• Reviews the content of the medical record for hospital and professional inpatient or outpatient records • Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using procedure codes as required • Determines the codes for all diagnoses and procedures using the Encoder software program • Assigns codes based on hospital and professional coding guidelines • Queries physicians as needed to clarify documentation within the patient’s record • Assists the Coding Quality and Professional Manager with training of new coding staff • Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies documented within patient records

• The coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance • Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets • The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines • Maintain a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing • Assure that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes • When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards • Achieve and maintain 95% accuracy in coding while maintaining a high level of productivity • Accuracy will be monitored during monthly reviews • Maintain average productivity standards as follows Work the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary • Correct and communicate charts that require re-bills to the facility daily for the re-bill process • Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met • Work directly with the IQC staff to ensure quality standards are being met for each facility • Provide accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request • Responsible for coding or pending every chart placed in their queue within 24 hours • Notify administrative staff in the event they cannot meet the twenty-four hour turn around standard • Coders are responsible for checking the Guidehouse email system at least every two hours during coding session • Maintain their current professional credentials while working for Guidehouse • Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility • Maintain HIPAA compliant workstations (reference HIPAA workstation policy) • Review and adhere to the coding division policy and procedure manual content • Work with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services • Communicate problems or coding principal discrepancies to their supervisor immediately

• Enter CPT and diagnostic codes into EMR accurately and efficiently. • Review and process insurance claims, ensuring accuracy and completeness of all necessary information. • Follow-up on unpaid claims via insurance portals and payor calls. • Post patient payments and EOB’s received in the mail, and ERA’s from payors. • Address and resolve billing disputes, discrepancies, and denied claims. • Process medical record requests and submit records via fax, e-mail or portal to third parties and/or insurance companies. • Maintain detailed records of billing inquiries, and resolutions.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medical Coding Specialist (Internally called a Coding Specialist) is responsible for creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types. - Receive and input client and examinee data in the system database. - Sort and verify each claim. - Process and review each claim and address all necessary modifications manually. Contact Client as needed. - Perform quality assurance on every case prior to completion. - Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times. - Process client invoicing in accordance with the client’s fee schedule. - Handle and respond promptly to incoming calls, emails, or faxes from clients requesting report status and/or information. - Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim. - Provide testimony in court as to the content of prepared reports, as required. Travel as necessary. - Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards, and legal regulations. - Perform quality assurance on various coding related reviews. - Perform other duties as assigned. Qualifications - High school diploma or equivalent required. - Minimum one year medical billing experience; or equivalent combination of education and experience required. - Must possess current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT or RHIA. CPMA certification preferred. Requirements - Must have a full understanding of aspects of medical billing. - Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used. - Must be able to cross-reference different types of billings to ensure consistency in the review process. - Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing, and CMS reimbursement guidelines. - Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must have a full understanding of HIPAA regulations and compliance. - Must be a qualified typist with a minimum of 35 W.P.M. - Ability to follow instructions and respond to management’s directions accurately. - Ability to work independently, prioritize work activities, and use time efficiently. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. - Must be able to stay focused and concentrate under normal or heavy distractions. - Must be able to work well under pressure and/or stressful conditions. - Must possess the ability to manage change, delays, or unexpected events appropriately. - Ability to follow all company policies and procedures in effect at the time of hire and as they may change or be added from time to time. Benefits - Competitive benefits (medical, vision, dental) - Paid time off - 401k