Senior Coding Specialist

EDUCATION:
Required: High school diploma or equivalent.
Preferred: Bachelor's degree in Health Information Management.

EXPERIENCE:
Required: Four years evaluation and management coding experience -OR- two years of OR/surgical coding/specialty coding experience.
Preferred: Experience in nursing with strong knowledge of the human anatomy.

LICENSURE/CERTIFICATION:
Preferred: One of the following American Academy of Professional Coders (AAPC) or American Health Information Association (AHIMA) Certifications:
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
Certified Coding Specialist (CCS)
Certified Coding Associate (CCA)
Certified Professional Coder (CPC)
Certified Professional Coder – Hospital based (CPC-H)
Certified Professional Coding Associate (CPC-A)
Certified Coding Specialist (CCS)
Certified Coding Associate (CCA)
Certified Professional Coder (CPC)
Certified Professional Coder – Hospital based (CPC-H)
Certified Professional Coding Associate (CPC-A)

Facility Job Description:
SUMMARY:
Function: Performs basic level-specific activities related to research projects and studies.
Scope: Impacts behavioral science research protocols.

ESSENTIAL JOB FUNCTIONS:
Assists with research projects within behavioral science. Registers study participants. Schedules and monitors study participation and attendance. Answers questions and corresponds with study participants. Conducts participant interviews and administers questionnaires. Handles biological specimens. Performs library research, data entry and coding.

SUMMARY:
Function: Performs complex specialty or multi-clinical coding and auditing functions of physician charges in accordance with departmental guidelines and governmental regulations.
Scope: Impacts the coding of procedures and visits for patients throughout the institution.

ESSENTIAL JOB FUNCTIONS:
Abstracts and/or assigns appropriate CPT 4 and ICD 9 codes by utilizing the Current Procedural Terminology and International Classified Disease Clinical Modification coding classification systems. Reviews and/or audits data submitted on charge documents and documentation provided by the faculty and/or mid-level providers of service to ensure appropriate codes are assigned in accordance with the state and governmental coding, auditing rules and regulations. Provides education and feedback to providers on coding and/or auditing guidelines. Compiles reports and statistical data as required.

May perform one or more of the following functions: Oversees and coordinates department work flow. Provides training and education to employees and providers. Works with management to develop strategies that maximize department efficiency and production.

MARGINAL OR PERIODIC FUNCTIONS:
Other duties as assigned.

SUPERVISION:
Received: Supervisor.
Given: None.

WORK CONDITIONS:
Office environment.

ESSENTIAL JOB FUNCTIONS:

· Abstracts and/or assigns appropriate CPT-4, HCPCS and ICD-9/ICD-10 codes by utilizing the Current Procedural Terminology & International Classified Disease Clinical Modification coding classification systems.
· Reviews patient encounters for accurate code assignment of all relevant diagnoses and procedures and may create APC or DRG group assignments.
· Visually reviews and/or audits data submitted on charge documents and documentation provided by the faculty and/or mid-level providers of service to ensure appropriate codes are assigned in accordance with the state and governmental coding & auditing rules & regulations.
· Initiates high-level decision-making by coding/auditing professional and/or facility multi-specialty services according to coding rules and regulations established by CMS, AMA, UTMDACC, or other payors.
· Assign appropriate modifiers, and apply guidelines as indicated through the Local Coverage Determinations (LCD), as well as the National Correct Coding Initiative (CCI).
· Communicate effectively, and demonstrate good interpersonal and professional skills when interacting with others throughout MD Anderson Cancer Center.
· May be required to attend group, or individual meetings with providers of service, or with administration.
· When necessary, will provide education to providers and others, as appropriate and be prepared to present clinical or surgical encounters for review and discussion.
· Compile reports with pertinent statistical data for review by management
· Report problems/concerns to management proactively
· Review and provides resolution of billing edits.
· Must communicate, both verbally and in writing, in a clear and concise manner.
· Meet or exceed department accuracy standards.
· Meet or exceed department production standards.
· Must have good understanding of governmental coding & compliance regulations.
· Maintain coding knowledge and skills through attending continuing education activities and reviewing pertinent literature, attending institutional coding meetings, AHIMA or AAPC seminars, or other educational forums.
· Must be flexible and adapt to changing work assignments.
· Must have the ability to work independently without close supervision
· Must exercise good independent judgment in making decisions according to department policies & procedures.
· Must demonstrate good teamwork skills
· Work in conjunction with management to develop strategies that maximize department efficiency and production for continuous process improvement
· May perform other duties, as assigned

EOE M/F/V

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