Coding Specialist

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Assign accurate and timely codes to the medical record for optimal reimbursement, data collection, and statistical reporting.

Reports to
As Assigned

Education, Experience and Skills Requirements
Must have successfully written the exam to become certified as a RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H or be able to acquire certification within two years. Completion of a two-year health information technician program with an associate degree of science degree is preferred. Encoder experience is highly preferred. Must have specific knowledge of diagnostic and procedural terminology, ICD-9 diagnosis and procedure, CPT, and HCPC coding schemes. Must have an understanding of drug groups, adverse effects of drugs, interaction between drugs, and treatment dosages. Must have a working knowledge of anatomy, physiology and pathophysiology to understand disease processes, treatment or management of conditions either medically or surgically. Must also have computer skills, the ability to interpret, analyze and abstract data/documentation, have good problem-solving skills, be self-motivated and have good time management and organizational skills. Must be current in coding schemes and have knowledge of prospective payment systems and clinical practices and technology.

Licensure/Certification Requirement
Must maintain certification in RHIA, RHIT, CCS, CCS-P, CPC or CPC-H by fulfilling continuing education requirements. If the associate is not certified at hire, the associate must be become so within two years of the date of hire.

Job Specific Competencies
  • Analyzes patient records to identify and assign accurate ICD-9-CM diagnosis and procedures, DRG and APC assignment, CPT, HCPC and ASC codes, following policies/procedures set forth by governing bodies.
  • Serves as a resource to providers and service areas on coding questions and guidelines and documentation. Provides education on appropriate coding schemes.
  • Actively participates in designated meetings and/or workshops and disseminates information to appropriate associates.
  • Tracks outstanding visits (MSR or discharges) and implements a plan of action for completion.
  • Monitors/assists with payor denials, patient complaints, and makes decisions on re-filing appeals for payment. Demonstrates ability to navigate and research appropriately in all payor websites.
  • Demonstrates knowledge of anatomy, physiology, pathophysiology, and understanding of disease processes, treatments and management of the patient's condition in order to accurately make coding decisions.
  • Demonstrates the ability to educate/train others as needed.
  • Demonstrates knowledge of various software applications-CCI, Logician, EDS, Dose Info, Encoder, etc.

Core Competencies
Customer Service
  • Interacts with customers in a warm and friendly way.
  • Takes immediate action to meet customer requests or needs.
  • Listens to understand what customers have to say.
  • Recognizes safety hazards and takes corrective action; seeking assistance when needed.
  • Demonstrates knowledge of operational policies and procedures.
  • Performs work safely, without causing harm or risk to self, others or property.
System Behavior
  • Makes a decision considering the impact of the decision on other areas.
  • Initiates collaboration with others outside of service area.
  • Demonstrates personal commitment to the principles, values, and ethics of the organization.
  • Models accountability for learning by sharing knowledge and learning from others.
  • Builds effective working relationships.
  • Expresses appreciation to others for their work.
  • Treats others with respect.

Leadership Competencies
  • Facilitates and supports change within the Sanford Health.
  • Demonstrates commitment to continuous learning for themselves and staff.

Information Management Competencies
  • Demonstrates skill in accessing, preparing and using information as relevant to position.
  • Verbalizes and demonstrates knowledge of procedures for maintaining security, confidentiality and integrity of employee, patient, family and other medical information.
  • Demonstrates ability to collect, analyze and present data as appropriate to position.

Equipment Competencies
  • Demonstrates skill in use of equipment relevant to position; verbalizes knowledge of appropriate safety procedures.
  • Consistently informs appropriate person of problems encountered with repairs or calibration of equipment.

Blood Exposure
  • This position is classified as a Category III position under OSHA guidelines with no risk of exposure to bloodborne pathogens and other potentially infectious materials.


Physical Requirements:
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