Coding Specialist - Inpatient/Outpatient

Description

Summary

Involves coding hospital visits, auditing provider charts, and providing annual training and 

support to our provider staff. Provide extensive knowledge of OB/Gyn coding procedures, 

including ICD-10, CPT, and HCPCS codes, and work closely with the Auditor, Revenue 

Cycle Manager, Quality Department, and provider staff to ensure accurate billing, coding 

compliance, and clean claim submissions. Reports to Revenue Cycle Manager.

Essential Functions

Coding:

•  Accurately code OB/Gyn inpatient, outpatient, and office visits, using appropriate ICD10, CPT, and HCPCS codes.
•  Ensure that all coding adheres to current medical and insurance regulations.

Chart Auditing:

•  • Perform annual audits of provider charts to ensure accurate documentation and

correct coding.

•  Review medical records to confirm that diagnoses and procedures are properly

documented and supported.

•  Provide feedback to providers regarding any discrepancies or documentation issues

Provider Training and Support:

•  Assist in training providers, their support staff, and billing staff on accurate coding

practices, documentation requirements, and regulatory updates.

•  Offer ongoing support to providers by answering coding and billing questions and

clarifying coding concerns.

Collaboration with Billing and Quality Departments:

•  Work closely with the Auditor, Revenue Cycle Manager, Quality Department, and

Provider Staff to ensure that all coding processes are consistent and aligned with best

practices.

•  Partner with the Quality Department to ensure coding accuracy and consistency in

quality initiatives, performance monitoring, and data collection efforts.

•  Assist the Quality Department in identifying coding-related trends that may impact

quality metrics and work together to improve processes.

Compliance and Best Practices:

•  Stay up-to-date with coding changes and regulatory requirements (ICD-10, CPT,

HCPCS, payer-specific guidelines).

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•  Ensure all coding is in compliance with federal and state regulations, payer 

requirements, and organizational policies.

Problem Resolution:

•  • Identify any coding errors, discrepancies, or issues in claims and work to resolve them.
•  Collaborate with billing staff and other departments to ensure timely resolution of any 

coding or billing issues.

Commitment to Purpose/Service:

•  Demonstrates a commitment to HealthNet’s mission, vision and values and supports 

organizational decisions and behaviors.

•  Demonstrates efforts to discovering, meeting and advocating for patient and customer’s 

needs.

HIPAA:

•  Maintains at all times the confidentiality of any patient or employee medical, financial, or 

other personal information, records and data to which there is access. 

•  Views, uses or discloses such information only for reasons necessary to perform duties.
•  Responsible to challenge unauthorized individuals from viewing such confidential patient 

or employee information or accessing restricted areas.

•  Maintains high level of integrity in dealing with highly confidential and often sensitive 

information, earns trust and respect of others, and exhibits behaviors that express the 

ethical practice of a healthcare organization. 

Commitment to Diversity:

•  Committed to fostering a diverse, inclusive, and equitable work environment, where all 

employees, whatever their gender, race, ethnicity, national origin, age, sexual orientation 

or identity, education or disability, feels valued and respected. 

•  Committed to a nondiscriminatory approach and provides equal opportunity for 

employment and advancement in respective departments, programs, and worksites.

•  Respects and values diverse life experiences and heritages and ensures that all voices 

are valued and heard. 

•  Committed to modeling diversity and inclusion and to maintaining an inclusive 

environment with equitable treatment for all.

The preceding essential function statements are not intended to be an exhaustive list of

tasks and functions for this position. Job descriptions provide a representative

summary of the major duties and responsibilities performed by incumbents. Other

tasks and functions may be assigned as needed to fulfill the mission of the

organization.

QUALIFICATIONS/KNOWLEDGE/SKILLS/ABILITIES<