P.O. Box 475
Biloxi, MS 39533
Position Description
Job Title:
Coding and Billing
Specialist
Department:
Accounts/Receivable
Summary
The role of the Coding and Billing Specialist is to review, analyze and assure the final diagnosis
and procedures as stated by the practicing providers are valid and complete. The Coding and
Billing Specialist must be able to assist in accurately coding medical procedures for providers
to ensure proper reimbursement. He or she will provide education to the providers to ensure
proper completion of Electronic Health Records (EHR) and proper assignment of ICD-9-CMICD10-CM, HCPCS, and CPT codes and will assist in billing and reporting duties as related to
coding expertise.
Knowledge, Skills, and Abilities
 Knowledge of Federal Laws and regulations affecting coding requirements.
 Knowledge of principles, practices and methods of current coding certificate required.
 Knowledge of billing practices required, FQHC preferred.
 Knowledge of medical records, EHR required.
 Knowledge of official coding conventions and rules established by the American
Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS)
for assignment of diagnostic and procedural codes.
 Ability to communicate clearly and concisely, orally and in writing.
 Excellent skills in mathematics.
 Ability to perform coding work requiring independent judgment with speed and
accuracy.
 Ability to examine and verify coding errors through audits.
 Ability to exercise a high degree of diplomacy and tact; excellent customer services
and interpersonal communication skills; Cultural sensitivity and demonstrated ability
to work with diverse groups/staff members.
 Knowledge of the importance of maintaining Protected Health Information (PHI)
records; able to maintain confidentiality under current HIPAA laws and regulations.
 Must be active, self-motivated, and able to learn multiple Medical Information
Systems (MIS) quickly.
 Ability to work independently to accomplish assigned work in a timely manner.
 Ability to understand and carry out verbal and written instructions
 Ability to understand and follow Coastal Family Health Center policies and procedures.
 Ability to plan one’s own work and accomplish in the allocated time.
 Ability to work and achieve outcomes under multiple priorities.
Qualifications/Education Requirements
To qualify for this position the employee must complete a program leading to a certificate or
associate's degree in medical coding, health information technology or another closely related
field. Completed coursework in medical terminology, basic and advanced ICD-9-CM and ICD10-CM coding, Healthcare Common Procedure Coding Systems (HCPCS), Current Procedural
Terminology (CPT) coding, healthcare reimbursement methods, and Behavioral Health coding
is preferred. Must have experience in computer data entry.
Core Competencies
 Audit records to ensure proper submission of services prior to billing on predetermined selected charges.
 Supplies correct ICD-9-CM/ICD-10-CM diagnosis codes on all diagnoses provided.
 Supplies correct HCPCS code on all procedures and services performed.
 Contacts providers to train and update tem with correct coding information.
 Attends seminars and in-services as required to remain current on coding issues.
 Audits medical records to ensure proper coding completed and to ensure compliance
with federal and state regulatory bodies.
 Accurately follows coding guidelines and legal requirements to ensure compliance with
federal and state regulatory bodies.
 Maintains all mandatory in-services.
 Maintains compliance standards in accordance with the Compliance policies and the
Code of Conduct. Reports compliance problems appropriately.
 Determines the final diagnoses and procedures stated by the physician or other health
care providers are valid and complete.
 Receives hospital information to property bill services for providers with admitting
privileges.
 Performs a comprehensive review for the record to assure the presence of all
component parts such as: patient and record identification, signatures and dates
where required and all other necessary data in the presence of all reports which
appear to be indicated by the nature of the treatment rendered.
 Evaluates the record for the documentation consistency and adequacy. Ensures that
the final diagnosis accurately reflects the care and treatment rendered. Reviews the
records for compliance with established reimbursement and special screening criteria.
 Analyzes provider documentation to assure the appropriate evaluation &
Management (E&M) levels are assigned using the correct CPT code.
 Assist in submitting claims and following up on claims status.
 Assist in the investigation of denied claims.
 Assist in locating and defining new process improvement opportunities.
 Performs other related duties, which may be inclusive, but not listed in the job
description.
Working Conditions
 Subject to stressful deadlines and competing priorities
 Subject to frequent interruptions
 May be required to work beyond normal work hours as necessary