JOB DESCRIPTION: Medical Coding Specialist
REPORTS TO: Insurance Supervisor
Why GLEC?
At Great Lakes Eye Care our core focus is to provide Christ-like, compassionate eye care. We provide exceptional multi-specialty treatment of eye disease for our communities and worldwide.
Our core values are:
• Selfless, Christ-like care for others.
• Relentless pursuit of excellence.
• Passion for patient experience.
• Teachable spirit, curious mind.
Position Summary:
The Medical Coding Specialist is responsible for evaluating medical records and charges to ensure completeness, accuracy, and compliance with current ICD-10 and CPT guidelines. The Medical Coding Specialist will also provide technical guidance and training on medical coding to physicians and staff.
Job Requirements:
• High school diploma or GED required.
• Possesses a current professional coding certification.
• Proficient in medical coding, including ophthalmology-specific CPT, ICD-10, and modifier
usage; stays current with payer guidelines.
• Demonstrates strong verbal and written communication skills in English to meet documentation and compliance standards.
• Maintains professionalism, confidentiality, and a respectful attitude in all interactions with
patients, coworkers, and providers.
• Works effectively in a team environment; adaptable, dependable, and willing to support
colleagues as needed.
• Exhibits strong multitasking, prioritization, and time-management skills to meet deadlines in a fast-paced setting.
Knowledge Base Required:
• Current ICD-10 and CPT coding guidelines
• Medical terminology, anatomy and physiology
• Ability to read and interpret medical records
• Ability to develop training materials related to coding and make recommendations for staff and physician education.
Duties and Responsibilities:
• Evaluates medical record documentation and associated coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10 and CPT codes.
• Evaluates records and prepares reports on topics such as documentation or coding issues for review by management and/or quality improvement committees.
• Makes recommendations for changes in policies and procedures. Develops and updates
procedures and processes to maintain standards for correct coding, to minimize the risk of fraud, waste and abuse, and to optimize revenue recovery.
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
• Reviews newsletters and attends workshops and webinars to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
• Educates and advises staff on proper code selection, documentation, procedures, and
requirements.
• Identifies training needs, prepares training materials, and works alongside the education and quality care team to train physicians and clinic staff on improving their skills in the collection and coding of quality health data.
• Prepares and distributes Good Faith Estimates in compliance with the No Surprises Act.
• Codes and bills outpatient visits, surgeries, injections, and diagnostic testing as needed.
• Responds to requests for coding assistance in real time, acting as a subject matter expert and offering support to staff members in all departments as needed.
PHYSICAL DEMANDS:
Long periods in stationary positions required throughout the work period. The person in this position needs to frequently move about inside the office. The person in this position frequently communicates with co-workers and doctors. Must have the ability to cope with physical and mental stress.
WORK ENVIRONMENT:
The person in this position is required to work in a clinic office setting. Travel may be required.
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.
