Coding Specialist
The Coding Specialist plays a critical role in ensuring accurate coding, compliance, and reimbursement for the Department of Surgery.

Primary Responsibilities:
Coding & Reimbursement: Reviews provider documentation and assigns the most accurate ICD-10 and CPT codes at the highest level of specificity to ensure appropriate billing and maximize reimbursement from third-party payors.
Compliance & Education: Supports physician and staff education on EVMS Medical Group Compliance Guidelines, HCFA Teaching Physician Guidelines, and industry coding standards. Provides feedback based on results of chart audits.
Auditing & Documentation Review: Assists with internal departmental “mini-audits” to confirm that inpatient and outpatient medical records contain sufficient documentation to justify the type and frequency of billed services.
Revenue Integrity: Ensures charges are submitted accurately and compliantly, directly impacting the Department’s ability to optimize revenue while minimizing risk.

Departmental Impact:
This position is essential to maintaining financial accuracy, compliance with federal and institutional guidelines, and safeguarding the Department’s reimbursement streams. By bridging clinical documentation, compliance, and billing, the Coding Specialist helps protect the Department from compliance risk while strengthening overall revenue performance.

ESSENTIAL DUTIES AND RESPONSIBILITIES
 Conduct monthly provider and staff coding and compliance education classes as needed/requested.

Assist with recommendations on implementing procedures for compliance within the surgery setting.

Assist as needed to develop Surgery compliance, coding, and billing policies and procedures based on the EVMSMG Compliance Plan and the HCFA Teaching Physician Guidelines.Review and “work” monthly denials and Medical Group Spread sheetsProcess/key physician charges

Ongoing review of compliance, coding, and billing, literature and guidelines effecting academic medicine and surgery practice.

Performs internal quality assurance charge/chart audits in a timely and consistent manner on both outpatient/inpatient services and surgical services.

Researches and assign the appropriate CPT/ICD-10 code based on the physician’s dictation, and other medical records to ensure that the most accurate combination of codes is used for each patient.

Audits and reviews the appropriateness of the CPT and ICD-10 coding selections, assuring that the appropriate link between the two coding procedures has occurred.

Functions as liaison between the physicians, the data entry staff and the Medical Group Billing Office to communicate and/or educated regarding the appropriate use of the procedural and diagnostic coding process.

Review monthly charge allowance reports to ensure utilization of appropriate fees in such a manner that reimbursement is maximized.

Supervise the charges being entered into patient record adhering to carrier regulations.

Each record reviewed for quality and content with special emphasis on:

• History and examination
• Procedure and diagnostic linkage
• Medical decision making

Completes and follows up on missing Information from Physicians when the information provided does not support the services rendered.

Coordinates the activity of coding and data entry to ensure their accuracy as they relate to the billing process

Review H&P and surgeon’s documentation for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.

Researches and analyzes data needs for reimbursement.

Analyzes medical records and identifies documentation deficiencies.

Serves as resource and subject matter expert to other coding staff.

Reviews and verifies that documentation supports diagnoses, procedures and treatment results.

Identifies diagnostic and procedural information.

Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.

Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.

Follows coding conventions. Serves as coding consultant to care providers.

Identifies discrepancies, potential quality of care, and billing issues.

Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.

Performs other duties as assigned.

EDUCATION and/or EXPERIENCE:
Associate degree plus four (4) years’ experience working with CPT/ ICD-9 & ICD 10 coding is required, including having a comprehensive understanding of all insurance types and requirements. Current CPC certification is required and must be maintained annually. Surgery coding experience a plus.