JOB TITLE: Medical Coding Specialist, UP
SUPERSEDES: *NEW*
FLSA: Non-Exempt
JOB CODE: 7531
ISSUED: 04/2026
REVISED: *NEW*
Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM, ICD-10-PCS, and CPT codes for billing, internal and external reporting, research and regulatory compliance; complete audits of coding and billing for validation; test coding applications.
Review appropriate provider documentation to determine appropriate principal diagnosis, co-morbidities and complications, secondary conditions, and surgical procedures; utilizes technical coding principles and MS-DRG or APC reimbursement expertise to assign appropriate ICD-10 codes and/or CPT-4 codes. Reviews and when necessary, corrects the patient admission source, status, and disposition upon discharge. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to Official Coding Guidelines. Advances coding knowledge and practice through continuing education.
Extract required information from clinical documentation and enters into the encoder and abstracting system, in accordance with the prescribed coding productivity standards.
Perform additional coding support activities including but not limited to audits for correct coding and billing, participates in testing and troubleshooting problems when implementing new applications or updates to existing systems, assists with training for new software applications.
Inpatient Coding Staff (in addition to the above):
-- Assign Present on Admission (POA) value for all inpatient diagnoses, and an External Cause code as appropriate.
-- Consult with the Clinical Documentation Specialist to resolve any unspecified or questionable diagnoses prior to final code assignment; determines whether a query must be sent to clarify ambiguous or unclear documentation.
Outpatient Coding Staff (in addition to the above):
-- Identify chargeable items for visits (i.e. IV infusions/hydration, GI procedures) and enter corresponding charges into the billing system appropriately.
-- Hold Bill & Denials Staff (in addition to the above):
-- Work inpatient and/or outpatient coding related bill alerts/edits/denials (i.e. NCCI, MUE, Medical Necessity, etc.), in accordance with established procedures.
-- Enter detailed notes to update the financial system if the alert/edit cannot be resolved or must be rerouted to another responsible party for research/resolution. Escalates alert/edit resolution issues as appropriate to minimize final billing delays.
May complete unit/department specific duties and expectations as outlined in department documents.
(To be completed by department)
General supervision is received from the supervisor or designee.
None.
Completion of a coding certification program or equivalent training to obtaincertification using ICD-10-CM, ICD-10-PCS, and the CPT-4 coding systems. One (1) year of related medical records coding experience may be substituted.
One of the following certifications within one (1) year as a condition of continued employment in this job classification:
-- Certified Coding Associate (CCA)
-- Certified Coding Specialist (CCS)
-- Registered Health Information Technician (RHIT)
-- Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA); or
-- Certified Professional Coder (CPC/CPC-A)
-- Certified Outpatient Coder (COC/COC-A)
-- Certified Inpatient Coder (CIC/CIC-A) by the American Academy of Professional Coders (AAPC); or
Specialty certification per the department needs such as:
-- Radiation Oncology Certified Coder (ROCC) by the American Medical Accounting and Consulting Inc (AMAC)
Two (2) years of experience in coding for hospital or physician practice.
Additional license/certification requirements as determined by the hiring department.
ICD-10-CM, and CPT-4 coding conventions.
CMS National Correct Coding Initiative Edits
Anatomy and Physiology.
Medical Terminology.
DRG/APC reimbursement.
Coding software familiarity.
Effective written and verbal communication skills.
Data entry.
The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.
This position is considered safety sensitive.
Job responsibilities listed herein are a general description of typical job duties, responsibilities, qualifications, and physical demands of the incumbents but should not be considered all-encompassing as actual responsibilities may additionally include other duties as assigned.
Job responsibilities listed herein are a general description of typical job duties, responsibilities, qualifications, and physical demands of the incumbents but should not be considered all-encompassing as actual responsibilities may additionally include other duties as assigned.