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What is a Medical Coding and Reimbursement Specialist?

Professional Medical Coders abstract medical terms from written and electronic health records. Coders analyze terms to determine diagnoses and procedures or services performed by providers.

Professional Medical Coders utilize at least three standard systems; ICD-10-CM (International Classification of Diseases), for diagnoses codes, CPT (Current Procedural Terminology) for procedure codes and HCPCS Level II (Healthcare Common Procedural Coding System) for supplies and special services. Coders carefully and accurately assign codes for each patient's service for statistical purposes and health insurance claims billing. Medical Coders are expected to understand and follow all rules and regulations required for accurate case coding.

Medical Reimbursement Specialists review medical claims with an understanding of insurance policy rules and regulations for private and government medical insurance. Reimbursement specialists submit claims, process payments, work with patient financial information, review denied claims, overpayments and more!

About Our Program

The Medical Coding and Reimbursement Specialist Certificate provides students an opportunity to develop ICD, CPT and HCPCS level II coding, claims and insurance processing skills to prepare them to become entry-level coders and reimbursement specialists. Students typically complete this 75 credit certificate within 5-6 quarters depending on Math and English placement and part or full-time status.

Students may enroll in the Medical Coding and Reimbursement Specialist Certificate program at the beginning of any quarter. The program hours are flexible with face-to-face and online classes.

Program Outcomes

Students who successfully complete this certificate program will be able to:

• Identify the different types of healthcare providers, disciplines, common departments and general structure found within healthcare organizations.
• Analyze and verify medical record and documentation accuracy and validity.
• Identify and define medical disease, diagnosis, procedural terms and abbreviations.
• Abstract diagnostic and procedural terminology to accurately assign ICD-10-CM, CPT-4 and HCPCS level II codes.
• Utilize a computerized encoder to determine procedure values based on RBRVS (resource based relative value scale), coding guidelines based on LCD (local coverage determination), NCD (national coverage determination) and CCI (correct coding initiative) edits.
• Define key legal concepts related to healthcare including the impact of ethics, morals, fraud and abuse in a healthcare setting.
• Apply legal principles, policies, regulations, and standards for the control and use of health information.
• Perform mathematical calculations needed to process a claim, determine allowed amounts, deductibles and co-payments, process cash, check and electronic payments, and balance monthly and yearly financial records.
• Complete all general medical practice management software tasks such as registering and scheduling patients, searching and reviewing medical records online, entering codes, payment and other electronic health record (EHR) tasks.