Coding Specialist-I

• Averages 10 front-end holds per hour
• Maintains a minimum of 90% coding accuracy.
• Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment.
• Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses.
• Ensures all diagnosis codes meet local and national medical necessity guidelines.
• Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services.
• Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.
• Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices.
• Independently reviews and resolves all assigned front-end claim holds.
• Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead.
• Escalates identified client trends to the assigned Coding Team Lead.
• Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification.
• Maintains and completes all CEU requirements.
• Performs other duties or tasks as assigned.

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