Medical Coding Specialist
Core
Reviews medical record documentation and accurately assigns ICD-10-CM, ICD-10-PCS, CPT IV, and HCPCS codes for outpatient visits including ancillary, urgent care, emergency department, observation, and interventional procedures.
Role type
Medical Coding Specialist
Builds
Clean claims for Medicare and other payers
Domain
Healthcare revenue cycle management
Required skills
ICD-10-CM coding, ICD-10-PCS coding, CPT IV coding, HCPCS coding, medical necessity verification, data abstraction, 3M software proficiency, Epic EHR experience, compliance with CMS guidelines
Preferred skills
AAPC or AHIMA certification, experience in HemOnc/Interventional Radiology, Ortho, Allergy/ENT, OBGYN, Cardio, General Surgery, Pediatric General Surgery, Pulmonology, AI process improvement
Technologies
3M software, LYNX, 3M 360 CAC, Epic, Computerized Assisted Coding (CAC)
Responsibilities
Assign appropriate codes supporting reason for visit and medical necessity, perform medical necessity checks for payers, monitor and process discharged not final billed/failed claims, maintain productivity and quality KPIs, stay abreast of CMS NCD/LCD guidelines, report inaccuracies and potential fraud
Seniority
Entry-level to Mid-level, hands-on IC
