GENERAL SUMMARY:
Under established coding principles and procedures reviews, analyzes, and validates the diagnostic and/or procedural codes applied from front-end coding and clinical teams for reimbursement and billing purposes. The CBO Coding Certified Specialist accurately abstracts information from the electronic health record for compilation of a patient database, which supports medical research projects, patient care evaluation, and administrative decision making related to patient care. The coding function is considered a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensure compliance with established
coding guidelines, third party reimbursement policies, and regulation and accreditation guidelines PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Successfully executes resolving accounts in SVC, claim edit, charge review, follow up, and denial work queues.
- Identifies patterns and trends with payer related and workflow issues and escalates to Supervisor.
- Meets established productivity and efficiency expectations.
- Correctly uses tools and resources available to resolve accounts.
- Maintains expert knowledge of coding, billing, and compliance within the revenue cycle related to all payers.
- Knowledge of applications used in the revenue cycle process related to hospital and professional claims processing. Demonstrates expertise in the following areas: SVC, claim edits, charge review, denials, and follow up.
- Represents CBO Coding in all communications with external customers, including third party insurance companies, and auditors.
Stays current with knowledge of coding guidelines and billing and regulatory practices
EDUCATION/EXPERIENCE REQUIRED:
- High school diploma or G.E.D. equivalent required.
- Billing or coding experience preferred.
- Some college or additional coursework in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.
- Prior experience in a healthcare revenue cycle position preferred.
- Must have through knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems. Six (6) months prior coding experience preferred, but not required.
- Strong organizational and time management skills required to effectively prioritize work.
- Ability to communicate effectively with colleagues, supervisor, and manager.
- Ability to work independently.
- Ability to work remotely.
- Proficient in medical terminology.
- Proficient in ICD-10 CM, CPT and HCPCS coding.
- Able to recognize patterns and trends and escalate to supervisors to support rootcause analysis.
- Able to assist other team members.
- Supports the standards set forth in the HFHS Code of Conduct by adhering to legal and ethical guidelines.
CERTIFICATIONS/LICENSURES REQUIRED:
Certification as a Registered Health Information Technician (RHIT), RHIT Certification eligibility, or CPC, CPC-A, CCS, CCP or CCA certification required. Additional Information
- Organization: Henry Ford Jackson Hospital
- Department: Home Health Care
- Shift: Day Job
- Union Code: Not Applicable
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Henry Ford Health System
Jul 03, 2025