A Clinical Coding Specialist is a professional medical coder who extracts precise information from documentation, test results, and reports and assigns the appropriate codes for creating claims to be paid by insurance carriers. Some of the most common duties are listed on the Clinical Coding Specialist Resume as – coding patient information for preexisting conditions; selecting the correct procedure codes for patient care, noting proper diagnosis codes, working with healthcare providers and billing services; managing other medical facility records, and organizing medical reports.
Some of the primary skills necessary for a career as a Clinical Coding Specialist include – strong knowledge of medical coding and medical terminologies, familiarity with clinical medical billing and healthcare systems, and the ability to ensure accuracy of health information data. One of the most common requirements for this post includes a degree in the healthcare domain. However, some employers might also hire those with relevant certification in medical or clinical coding.
Headline : Top-performing billing and coding professional seeking a secure position by utilizing skills in HCPCS and insurance carrier knowledge with hands-on experience in CPT, ICD-10 coding, and medical records to increase the overall efficiency in the billing department.
Skills : Type 75 Wpm, Microsoft Word, Powerpoint, 10-Key.
Description :
Expected to make appropriate corrections to claims requiring CPT/HCPCS revisions.
Expected to assign and sequence codes based on medical record documentation in accordance with the official coding guidelines of the Cooperating Parties and any other official CMS and Local Medical.
Review Policy guidelines and definitions.
Expected to abstract and enter coded data and designated quality management and statistical for hospital reporting requirements.
Expected to review and respond to identified encoder APC/ASC and other Payer edits during the data abstraction process prior to completion of coding and billing.
Assists in the resolution of identified APC and other payer edit issues upon notification by administrative entities.
Expected to review outpatient encounters (Emergency Department, Outpatient Testing, and therapeutic encounters requiring minimal Procedural system coding) and associated information (i.e., scripts & diagnoses) for the determination and accurate assignment of all appropriately documented diagnoses, procedures, and modifiers, utilizing ICD-9-CM, CPT-4 and any other designated coding nomenclature systems.
Experience
5-7 Years
Level
Executive
Education
Clinical Medical Coding And Billing
Clinical Coding Specialist Resume
Summary : Adaptive, results-oriented professional with 20 years of experience in the Healthcare industry who has served in various roles in Health Information Management encompassing Hospital Outpatient Coding, Operations, and Customer Service. Flexible team player who thrives in environments requiring the ability to effectively prioritize and manage multiple tasks.
Skills : Bilingual English, Vietnamese, Microsoft Office Suite, Computer, Electronic Medical Records.
Description :
Code outpatient simple and complex medical records for reimbursement and research.
Abstract clinical data to assign appropriate diagnosis and procedure codes on simple and complex medical records resulting in APC group assignments.
Review and provide resolution of NCCI and CCI edits.
Review and provide resolution of coding edits for the billing department.
Review local and national coverage policies and provide resolution of medical necessity edits.
Participate in all team meetings and required coding education.
Reconciliation of bills holds to hospital standard.
Experience
10+ Years
Level
Senior
Education
Associate Of Applied Science In Health Information Technology
Clinical Coding Specialist Resume
Objective : A highly motivated, self-starter looking for an opportunity to put my degree in Healthcare Administration and Coding Certification to work for your organization. Combine years of coding experience with excellent organizational skills and you will see that can be a tremendous asset.
Skills : Microsoft Office, Deadline Management
Description :
Abstracts pertinent information from patient medical records, assign appropriate ICD-9-CM codes creating HCC and/or RxHCC group assignments.
Assign exception codes when documentation in the record is inadequate.
Complied with HIPAA laws and regulations.
Review and analyze member's medical records to capture ICD-9-CM codes to the highest specificity in accordance with CMS HCC.
Review/audit medical records to determine if specific diagnoses were omitted from claims submission.
Conduct prospective reviews and reconciliation for targeted claims to evaluate Certificate of Coverage limitations.
Reset reviewed claims to Claims Department for final review and adjudication process.
Experience
2-5 Years
Level
Junior
Education
Medical Coding And Billing
Clinical Coding Specialist Resume
Headline : Certified Coder with over 8 years experience in medical insurance offices mostly working remotely. Advanced knowledge of ICD 9 and Medicare Risk coding. Previous experience in Amisys Advance, Voyager, Epic, Case Trakker, Mass, etc. College-level coursework in Anatomy and Physiology, Medical Terminology, Pharmacology, and Health Information Management. ICD-10 training recently completed through AAPC.
Skills : Data Entry, Dependable, Team Player, Medical Terminology, Medical Transcriptionist, Strong Written/verbal And Communication, Organization.
Description :
Performed data quality reviews of outpatient and/or inpatient records to validate ICD-9-CM and CPT-4 codes, and MS-DRG group appropriateness, as applicable.
Ensured documentation compliance with all coding mandates and reporting requirements.
Evaluated clinical documentation to ensure quality, completeness, and consistency as it relates to code selection and reimbursement.
Reviewed medical records for documentation of, HCC that has been exacerbated or required treatment with medications or monitoring, or a risk factor for the patient's treatment.
Provided training to healthcare professionals in the use of coding guidelines, proper documentation techniques, medical terminology, and disease processes as they relate to code selection and/or MS-DRG assignment.
Started as a member of the coder-in-training program and worked into a full time position.
Coded Ancillary, ED, and Series Accounts.
Managed time efficiently and always exceeded productivity goals.
Experience
5-7 Years
Level
Executive
Education
Certificate In Medical Coding/Billing
Clinical Coding Specialist Resume
Objective : Service-focused, dependable Certified Medical Coder. Extensive experience in assigning appropriate diagnostic and procedure codes in research and hospital settings. Knowledge of ICD-9-CM, CPT-4, and ICD 10 coding fundamentals. In-depth knowledge of federal and state guidelines and regulations pertaining to coding and billing practices.
Skills : Proper Use Of ICD-9-10, CPT, And HCPCS Codes Understand.
Description :
Coded inpatient accounts.
Conducted HCC risk adjustment retrospective chart reviews for proper diagnosis coding from various chart types.
Inpatient to ensure the highest level of diagnosis code was utilized in each date of service reviewed and document findings.
Coding of all service types for multiple facilities.
Coding of emergency room visits to the highest level of service using CPT-9 and ICD-9 codes.
Provide feedback and training support to physicians on proper documentation to ensure appropriate billing and allow for maximum reimbursement.
Received both ICD-9 and ICD-10 training.
Experience
0-2 Years
Level
Entry Level
Education
BS In Certified Professional Coder
Clinical Coding Specialist Resume
Objective : Avidly pursuing continuous growth and development in the dynamic field of medical coding. Magna cum laude certification, four years of practical experience, rich history in the insurance industry, and fully certified in ICD-10 render me a valuable addition to any health organization seeking the services of a professional coder.
Skills : Certified Professional Coder, ICD-10 proficient, Knowledge of Medical Billing/Denials and Insurances, IDX Proficient, Ingenix Encoder, Epic system-Electronic Medical Records, OnBase System.
Description :
Chart review for proper diagnosis coding from various chart types (physician, hospital outpatient, hospital inpatient).
Ensure that the highest level of diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage.
Abstract HCC codes for review from charts for HCC risk adjustment.
Adhere to all coding guidelines.
Coded and abstracted Emergency Room records for pediatric facility.
Maintained and exceeded expectations to keep our accounts receivable as low as possible.
Review various chart types to insure proper diagnosis coding.
Experience
2-5 Years
Level
Junior
Education
Associate Of Applied Science In Information Technology
Clinical Coding Specialist Resume
Objective : Clinical Coding Specialist is responsible for coding, billing, and reimbursement of inpatient and outpatient services at the hospital. Receive patient bills from outside providers, evaluate bill for accuracy, and submit to insurance companies for reimbursement.
Skills : Ingenix Encoder, Epic system-Electronic Medical Records, OnBase System.
Description :
Ensure the highest level of diagnosis coding was utilized.
Ensure all appropriate HCC.
Performed retrospective and prospective HCC coding audit for clients.
Worked remotely from home using company-issued equipment.
Developed new policies, procedures, and forms for SHS use approved by the director to improve patient communication and efficiency.
Assignment of Benefits, International Student check-in information, pharmacy medication exhaustion list, credit card collections, etc.) Post charges.
Properly assembling charts and protecting the integrity of medical information.
Experience
2-5 Years
Level
Junior
Education
Certificate in Medical Coding
Clinical Coding Specialist Resume
Objective : Clinical Coding Specialist is responsible for the coding, diagnosis and treatment of patients in a hospital or health care setting. They are expected to document patient data by using a standard format, such as ICD-9-CM (International Classification of Diseases, 9th Revision), and by using an agreed upon set of standardized procedures. The Clinical Coding Specialist may also provide input on how to improve the coding process.
Skills : Epic system-Electronic Medical Records, OnBase System.
Description :
Developing the HCC Gap.
Analyzing Protocol; collaborating and analyzing chart review result of coding team members.
Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical.
Coding by facility assignment of Inpatient, Outpatient, and clinical encounters.
Varied by a facility as required per hospital policy and procedure.
Various coding assignments according to current coding guidelines, CCI, and CMS (MEDICARE) required the use of various abstracting and encoder.
Participated in State and National conventions.
Experience
2-5 Years
Level
Junior
Education
BS In Certified Professional Coder
Clinical Coding Specialist Resume
Objective : Clinical Coding Specialist is responsible for coding and reviewing clinical documentation. This includes documentation from physicians, patients, and other healthcare workers. Ensure that the coding system is not only used correctly by clinicians but also by other healthcare workers such as pharmacists, radiologists, etc.
Coding of Inpatient, Outpatient, and clinical encounters according to current coding guidelines along with CCI and CMS (MEDICARE) using MEDITECH.
Reconciliation of bills holds to hospital standard.
Communications, written and oral, with various departments, physicians, and business offices.
Work Retrospective Queues for Aetna/Coventry-facility and non-facility as well as Prospective Queues for Aetna/Coventry and Humana.
Abstracted and coded clinical data identified from pertinent data from the patient electronic.
Review various chart types (physician, hospital inpatient/outpatient) for proper diagnosis coding and ensuring that the highest level of diagnosis.
Coded Interventional Radiology.
Ensure consistency of coding across and within projects with particular emphasis on adverse.
Experience
2-5 Years
Level
Junior
Education
Certificate in Medical Coding
Clinical Coding Specialist Resume
Objective : Clinical Coding Specialist is responsible for ensuring accurate and timely coding of all clinical encounters. This includes ensuring that the appropriate code is used for each clinical encounter, assigning codes to new services, updating existing codes as needed, and researching and reporting on coding issues.
Skills : Microsoft Office, Technical Plan Execution, Fast Learner, Detail-Oriented, Organized.
Description :
Evaluated outpatient/inpatient medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and other documentation.
Performed HCC/Medicare Risk Adjustment audit to ensure patients' records have been appropriately coded to the highest level of specificity.
Outpatient Coder coding ancillary, labs, procedural radiology, emergency room, wound care, infusion center, and sleep lab encounters.
Trained as a reimbursement analyst and work the APC report and help the manager addresses patient accounting requests and reconcile unpaid.
Assign codes in accordance with AHA official coding guidelines, CMS regulations, and hospital policy.
Utilize physician query process to obtain missing information for clarification of documentation for accurate code assignment.
Expected to make appropriate corrections to the claims requiring ICD-9-CM procedure or diagnoses code changes.
Expected to participate in quality reviews for performance improvement.
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