The Medical Records Coder II is responsible for accurately coding complex medical records using ICD-10-CM and CPT-4 conventions, ensuring specificity of diagnoses and procedures for optimal reimbursement. This role also involves coordinating and reviewing the work of subordinate employees and assisting with training programs.

The Authorization Specialist obtains benefits and authorizations for various medical services, determining protocols for each health plan and performing billing duties to ensure timely payment from carriers and patients. This role involves collaborating with providers to ascertain authorization based on medical necessity and communicating with insurance companies to verify benefits and obtain precertification.

The role involves utilizing specialty databases to abstract patient data from electronic medical records for medical registry application, ensuring high abstraction accuracy aligned with quality standards. Responsibilities also include compiling data into reports, acting as a liaison for clinical improvement teams, and maintaining quality databases in compliance with regulatory requirements.

This role involves analyzing and auditing documentation to accurately assign codes from the appropriate classification system, working closely with providers and documentation integrity staff for translation and education. The specialist will also assist with quality audits, denial management, and monitoring documentation patterns to ensure proper reimbursement.