Revenue Cycle Coding Specialist

Overview

The Revenue Cycle Coding Specialist supports the financial sustainability of PPGOH by ensuring accurate medical coding, billing, and accounts receivable resolution. This role applies detailed knowledge of coding guidelines, payer requirements, and documentation standards to support compliant reimbursement and timely claim resolution. The Specialist conducts coding audits, provides education and feedback to providers and operational leaders, and assists with credentialing and compliance activities as assigned.

This position requires strong analytical skills, attention to detail, and the ability to manage multiple priorities within established deadlines. In alignment with PPGOH’s “In This Together” ethos, the role collaborates across departments to strengthen Revenue Cycle processes and support departmental and affiliate goals.

• Medical Coding and Claim Resolution:
  Conduct audits and coding reviews to ensure documentation is accurate and precise; assign and sequence CPT, HCPCS, and ICD-10-CM codes based on clinical documentation; review medical records to ensure documentation supports billed services and coding accuracy; correct coding errors and prepare claim resubmissions and appeals related to coding denials; submit electronic claims as scheduled and follow up on clearinghouse and payer rejections;
  
  resolve assigned coding-related account balances, including debit and credit balances.
• Maintain working knowledge of Medicare, Medicaid, Managed Care, and Commercial payer coding requirements.
• Provider Communication and
  
  Education:
  
  Communicate with providers and clinical staff to clarify documentation and coding questions; provide encounter-specific coding education and feedback including annual E/M guideline updates; respond to coding inquiries from Health Center and Contact Center staff within scope of responsibility.
• Audit Participation and Compliance Support:
  Participate in coding audits and reviews as assigned; implement corrective actions related to audit findings and documentation improvement; maintain accurate documentation in electronic systems and adhere to all HIPAA and regulatory requirements; demonstrate professionalism, teamwork, and effective communication; participate in cross-training and continuous improvement efforts within the Revenue Cycle; comply with all agency policies, procedures, and applicable laws and regulations.

None

• Must have strong interpersonal and communication skills: both verbal and written; ability to relate to persons of diverse backgrounds
• Ability to handle highly confidential and sensitive matters and documents
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Ability to interpret a wide variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
• Ability to prioritize and handle multiple projects
• Ability to demonstrate initiative and to work with minimal direction
• Ability to perform duties in a manner that exhibits commitment to providing quality service and continuous improvement
• Strong general technology skills; proficient utilization of Excel, Word, and Windows environment;
  Epic or other practice management systems experience is a plus
• Excellent typing and 10-key speed and accuracy

Bachelor’s degree preferred;
High school diploma or GED;
Minimum 2 Years’ Direct Experience With Medical Coding;
Minimum 2 years’ direct experience billing and coding in medical office practice;
Prefer experience in credentialing providers in a medical office practice

Current Coding certification (CPC) is required.

Planned Parenthood Of Greater Ohio Is Committed To Providing Equitable, Respectful, And High-quality Care In An Inclusive Environment. The Revenue Cycle Coding Specialist Is Expected To Support This Mission Through Professionalism, Collaboration, And Adherence To Shared Values By

• Demonstrating empathy; recognizing inherent worth and treating individuals with respect.
• Protecting confidentiality and sensitive information.
• Appreciating Planned Parenthood culture and recognizing cultural strengths.
• Striving to comprehend diverse cultures of our Associates and the importance of diversity in providing competent services.
• Valuing everyone equally and striving for the highest standard of health for all, regardless of background or identity.