Medical Coding Specialists work on the financial and administrative side of the medical industry. Medical Coders read a patient’s medical chart and analyze it to determine the patient’s diagnoses and any procedures performed. Following strict federal guidelines, coders categorize those diagnoses and procedures according to a national classification system, assigning a specific numeric or alphanumeric code to each diagnosis or procedure. The result of their work is used for reimbursement and data purposes.
In other words, a medical coder translates the documents in a patient’s chart into codes. Coders may use computer software to code, fill in the blanks in handwritten notes or work with some combination of paper and digital files. Each hospital, clinic or physician’s office does it a little differently. To accurately read a patient’s chart and document the information within, a professional coder must have an extensive knowledge of anatomy and physiology, disease processes, pharmacology, the different classification systems, and more.
Medical Coders work in different medical coding situations—hospitals, clinics, physician offices and nursing homes. Medical insurance companies also hire medical coders. The duties vary according to the type of facility and the level of the credentials of the medical coder.
The coding professional is an invaluable part of the healthcare team and often serves as a resource person for physicians, administrators and other allied health providers for information on documentation, regulations, reimbursement and data collection.
There is a high demand for medical coders and many confuse this job with medical billers because the work of these two careers is closely related. Both careers are fast-paced and play a vital role in the connection between health care providers, patients and insurance companies. However, billing and coding are two separate professions.
- Review medical records, provider notes, dictation, and other documentation to determine appropriate procedure codes and diagnosis codes, in accordance with the coding guidelines and federal regulations.
- Utilize appropriate specialized medical classification software to assign procedure and diagnosis codes for insurance billing.
- Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.
- Conduct medical records research and corresponds with insurance companies and healthcare professionals to resolve issues regarding claims denied for payment.
- Provide feedback to physicians and other providers regarding coding guidelines and requirements.
- Maintain up-to-date knowledge and understanding of coding and insurance processing guidelines with continuing education and training.
Skills and Abilities Needed to Perform Job:
- Experience and knowledge in reviewing and assigning accurate medial codes for diagnoses procedures and services performed by physicians and other qualified healthcare providers.
- Knowledge of ICD-9 and ICD-10 code diagnosis to determine the principal and significant secondary diagnosis.
- Proficient across a wide range of services including E/M, anesthesia, surgery, radiology, pathology, and medicine.
- Knowledge of medical coding guidelines and regulations including compliance and reimbursement.
- Understand how to integrate medial coding and payment policy changes into a practice’s reimbursement processes.
- Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services.
- Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases and deformities.
- Knowledge and use of Microsoft programs specifically including spreadsheet and word processing software.
- Critical Thinking – Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Reading Comprehension – Ability to understand written sentences and paragraphs in work related documents.
- Written Comprehension – Ability to read and understand information and ideas presented in writing.
- Deductive Reasoning – Ability to apply general rules to specific problems to produce answers that makes sense.
- Inductive Reasoning – Ability to combine pieces of information to form general rules or conclusions.
- Information Ordering – Ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules.
- Near Vision – Ability to see details at close range.
- Oral Expression – Ability to communicate information and ideas in speaking so others will understand.
Desired Work Style Attributes:
- Attention to details
- Integrity – Honest and ethical
- Dependability – Reliable and responsible
- Cooperation – Pleasant with others
- Independence – Job requires developing one’s own way of doing things, guiding oneself with little or no supervision and depending on oneself to get things done
- Stress Tolerance – Accepting criticism and dealing calmly in stressful situations
- Initiative – Willingness to take on responsibilities and challenges