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View salary and benefits informationResearches and develops the pre-certification insurance policy standards and criteria used by case management and utilization reviewers that will ensure that requested medical services are appropriate and medically necessary. Collaborates with medical professionals to resolve questions about policy development and standards. Assigns correct ICD, CPT, or other coding assignments for medical procedures that support policy standards in claims systems. Provides expertise and solutions to users regarding the appropriate coding for claims. Has broad knowledge of medical coding systems. May require a more...
The Reimbursement Coding Verification Specialist reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Determines the extent to which patients' insurance covers their treatments. Being a Reimbursement Coding Verification Specialist may assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. In addition, Reimbursement Coding Verification Specialis more...
Supervises and trains a team of medical coders to ensure medical records are coded with accuracy and completeness. Ensures medical records coding operations follow the latest guidelines and compliance standards. Maintains required documentation and confidentiality of patient records. Implements processes for coding operations that support the needs of other healthcare partners. Develops and maintains up-to-date knowledge of the latest ICD and CPT coding versions and ensures coders receive updates and training on classification or guideline changes. Is a certified medical coder and the exact ty more...
The Medical Record Coding Quality Specialist reviews insurance payments and denials and recommends billing corrections. Audits medical records to ensure compliance with the organization's coding procedures and standards. Being a Medical Record Coding Quality Specialist typically requires a bachelor's degree. Trains staff members on the coding process. In addition, Medical Record Coding Quality Specialist typically reports to a supervisor or manager. Requires CPC (Certified Professional Coder) certification from the American Association of Professional Coders. Medical Record Coding Quality Spec more...
The Medical Record Documentation and Coding Review Specialist reviews insurance payments and denials and recommends billing corrections. Audits medical records to ensure compliance with the organization's coding procedures and standards. Being a Medical Record Documentation and Coding Review Specialist typically requires a bachelor's degree. Trains staff members on the coding process. In addition, Medical Record Documentation and Coding Review Specialist typically reports to a supervisor or manager. Requires CPC (Certified Professional Coder) certification from the American Association of Prof more...
There is currently no job description for Clinical Coding Specialist. Be the first to submit the job responsibilities for a Clinical Coding Specialist.
The Clinical Coding Specialist I assigns required DRG (diagnosis-related grouping) codes. Abstracts clinical information from medical records and assigns the appropriate ICD or CPT codes using industry-standard coding guidelines. Being a Clinical Coding Specialist I performs quality audits of work. Works with coding databases and software to input and maintain data according to standard procedures. In addition, Clinical Coding Specialist I maintains and up-to-date knowledge of coding and documentation requirements. Does not require a medical coding certification. Requires a high school diploma more...
The Clinical Coding Specialist III assigns required DRG (diagnosis-related grouping) codes. Abstracts clinical information from medical records and assigns the appropriate ICD or CPT codes using industry-standard coding guidelines. Being a Clinical Coding Specialist III performs quality audits of work. Works with coding databases and software to input and maintain data according to standard procedures. In addition, Clinical Coding Specialist III maintains and up-to-date knowledge of coding and documentation requirements. Requires a medical coding certification. The exact type of coding certifi more...
The Clinical Coding Specialist II assigns required DRG (diagnosis-related grouping) codes. Abstracts clinical information from medical records and assigns the appropriate ICD or CPT codes using industry-standard coding guidelines. Being a Clinical Coding Specialist II performs quality audits of work. Works with coding databases and software to input and maintain data according to standard procedures. In addition, Clinical Coding Specialist II maintains and up-to-date knowledge of coding and documentation requirements. Requires a medical coding certification. The exact type of coding certificat more...
Supports the development and implementation of compliance programs, policies, reporting, and practices for an organization or business. Monitors activities impacted by regulatory requirements related to the organization's governance and any industry-specific or location-specific laws. Utilizes established internal controls and auditing systems to identify, detect, and correct noncompliance. Implements changes to compliance processes due to new or amended regulations. Prepares and updates communication materials. Assists with training initiatives that inform stakeholders about compliance requir more...
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