The Certified Coding Specialist functions as an integral member of the team/healthcare team and is responsible for reimbursement to The Everett Clinic physicians, to ensure accurate ethical coding of claims for integrity of data and to prevent fraudulent billing and inappropriate claims from reaching insurance plans or patients. All individuals associated with The Everett Clinic are also charged with learning, knowing and following the written legal standards established by the Corporate Compliance Committee which relate to their duties.

The Certified Coding Specialist is responsible for and not limited to: 

• Audits EPIC work queues and paper charge tickets, reviewing documentation for correct coding.  Focus on accuracy of CPT and ICD-10-CM coding used in all aspects of compliance audits and charge capture. Applies knowledge of CPT, ICD10-CM, HCPC regulations during review process. Utilizes strong proficiency of Federal, State and Commercial payor regulations in performance of audits, and uses strong communication skills to interact real time with staff and providers. Performs and communicates corrections and addendums of electronic medical records to apply HCC rules as indicated through standard work processes.

• Education of staff and providers on accurate coding and documentation of levels of service, procedures, ICD10 diagnosis and HCC coding. Monitoring of interface systems including, but not limited to: Epic, Softlab, Provation, Mosaiq, OpTime, Cellnetix, in front end and post review process. Work on line and paper charges for compliance and correct coding.

• Identifies and solves coding problems prior to charge entry to ensure correct coding for physicians and The Everett Clinic.

• Training and Problem Solving

• Educate physician and clinical staff on appropriate documentation as required by medical review.

• Educate physicians, clinical and business services staff on EPIC and manual charge capture.

• Institute and educate on all annual coding updates for CPT and ICD-10-CM

• Corporate Compliance/Peer Review audit includes review of documentation and reporting of any coding or billing problems to the Coding and Compliance Manager for follow-up and new physician monthly meetings.

• Participate in special audits as instructed under the compliance yearly work plan or as identified throughout the year as areas of concern.

• Interfaces with clinical and ancillary departments to answer coding questions and clarify new issues or services.

• Assist Business Services with billing problems that are identified through system edits or denials. Follow-up with physician education and review.

Preferred Experience and Credentials:

• Knowledge: Must have strong Medical Terminology background. High level understanding of CPT, ICD-10, HCPC coding guidelines. Strong background across a wide range of medical record review processes, including: Evaluation and management, anesthesia, surgical services, radiology, pathology and medicine. Sound knowledge of: CCI (Correct Coding Initiative), insurance regulations (i.e., Medicare, Labor and Industries, Welfare) HCC, and regulatory compliance issues.

• Skills: Excellent time management, decision-making, organizational and communication skills. General interpersonal skills to work as a team member and independently

• Abilities: Ability to use various Microsoft Suite software and other applications such as: Outlook, Word, Excel, EPIC, PowerPoint, Codelink and other software applications as required.  Ability to work directly with physicians and clinical staff in an educational and resource role. Ability to analyze, problem solve and make appropriate decisions in performance of compliance audits. Requires the ability to establish priorities and coordinate several activities at the same time. 

• Education:  High School Diploma or GED preferred.

• Experience: Minimum of three (3) years coding experience required; minimum of one (1) to two (2) years’ experience in clinical setting or healthcare business office setting preferred.

• Certificate/License:  CPC certification or equivalent required.

Schedule: This position is 40/hours per week to include Monday-Friday.

Interested in learning more?  Let’s talk about our opportunities and your career growth! 

• Employees are required to screen for symptoms using an approved symptom screener prior to entering the work site each day, in order to keep our work sites safe.
• Employees must comply with any state and local masking orders. In addition, when in a worksite building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
• UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.