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Coding & Reimbursement Specialist

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Certificate – Code #1671

Erica Matteson, RHIA, Program Coordinator
Email address: matteses@alfredstate.edu

Securing accurate and appropriate payment for health care services is a challenge for health care providers, insurance companies, and patients. Today’s complex health care insurance and governmental payment systems depend on medical coding to determine proper payment. The coding and reimbursement specialist program incorporates the knowledge and skills you will need to assign the correct code for prompt and accurate reimbursement. As a C&RS professional, you will analyze patient records, assign ICD (ICD-10-CM/ICD-10-PCS), CPT, and HCPCS codes to diagnoses, procedures, and services provided to patients for timely and accurate health care billing, reimbursement, and medical necessity.

Online instruction is organized under the health information technology program (HIT program). This means if you initially select the C&RS program, you can transfer courses into the HIT program and earn your Associate in Applied Science (AAS) degree.

Advantages

  • Alfred State’s comprehensive coding certificate program offers individuals the opportunity to pursue a business-related career essential to the health care industry.
  • Alfred State's C&RS program is entirely internet-based education, with the exception of the 80 hours of Professional Practice Experience.
  • Teaching faculty in C&RS curriculum have real-world Health Information Management (HIM) industry experience.

Program Student Learning Outcomes

  • Apply biomedical knowledge (including medical terminology, anatomy & physiology, pathophysiology, and pharmacology) to apply diagnosis/procedure codes (ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II) according to current nomenclature.
  • Use established federal guidelines, accreditation standards, and APC and DRG calculator/grouper software to comply with health care documentation (review), reimbursement, and reporting requirements.
  • Apply HIM knowledge as defined by organizational policy and external regulations (e.g., Medicare, Medicaid, and managed care) and standards to maintain the accuracy and completeness of the patient record.
  • Apply HIM knowledge of policies and procedures for confidentiality and security measures regarding the access and disclosure of protected health information (PHI) to authorized users.
  • Apply HIM knowledge in the collection, maintenance, and reporting of data for clinical indices/databases/registries to meet specific organizational and regulatory needs for the purposes of medical research and education.
  • Apply HIM knowledge of legal, ethical, accreditation, and certification standards as appropriate for the management of health information.
  • Apply basic methods when calculating descriptive, institutional, and health care vital statistics.
  • Apply the use of common software applications (e.g., spreadsheets, databases, word processing, graphics, presentation, email, and so on) and HIM-related software applications (e.g., release of information, electronic health record, patient record abstracting, and so on).
  • Apply HIM knowledge to promote ethical standards of practice to health information management and coding.
  • Demonstrate critical thinking to problem-solving and reasoning skills to health information management and coding practices.

Professional Practice Experience

Students complete non-paid professional practice experiences (PPEs) in the health information (coding) department of a health care facility (80 hours) in their last semester of study.  Students are not a substitute for paid staff during PPEs, which means they are expected to receive appropriate supervision and mentoring during completion of all tasks. 

The Joint Commission "Hospital Accreditation Standards Manual" requires hospitals to implement “a process to ensure that a person’s qualifications are consistent with his/her job responsibilities.” This standard “applies to staff, students, and volunteers,” and it further states that the hospital is responsible for verifying “the following according to law, regulation, or hospital policy: information on criminal background.” As such, Alfred State students who complete PPEs in the C&RS program may be required to undergo a criminal background check prior to placement at the facility. In addition, the facility may require students to undergo a physical examination (on-site at the facility or by the student’s primary care provider) prior to beginning the PPE. The physical examination includes drug screening, a TB test, and/or DTB, hepatitis B, and/or MMRV immunization or status. Students may be required to incur costs associated with the criminal background check and/or physical examination.

Students may be required to attend an on-site orientation at the professional practice facility, which could be several days in length beyond the 80 PPE hours. Students must make appropriate arrangements with their current employer to complete the 80 hours at the PPE host site.

C&RS Entrance Requirements & Recommendations

Required:

  • High school biology or equivalent
  • Must be able to visually read computer monitor
  • Must be able to use keyboard and mouse
  • Must be able to attend Professional Practice Experience (PPE) course, including 80 hours at a health care facility within reasonable driving/travel distance to home.
  • Keyboarding, MS Office Professional

Working in the health information management (HIM) profession requires long periods of standing and/or sitting. Job duties typically include handling paper documents and use of computer screens. Near-vision reading of paper records or computer screens, including the use of multiple computer applications, is required 95 percent of the time. Documents are handwritten on paper, and other documents and information used are on computer screens, including scanned documents and images. The computer screen fonts may be small. HIM professionals spend the greater portion of the work day reading and analyzing both handwritten and computerized documents, and use multiple software applications such as the electronic health record. The extensive use of a computer keyboard and mouse is required. Individuals should assess their personal limitations and abilities within these working environments, as HIM candidates will be assessed in all of these skill sets during the hiring process.

Continuing Education Opportunities

Graduates are eligible to continue their education by completing the health information technology (HIT) program. The HIT program is also Internet-based.

Occupational Opportunities

  • Hospitals and other health care facilities
  • Clinics and physicians’ offices
  • Insurance companies
  • State and federal agencies
  • Legal firms
  • Software companies
  • Consulting firms

Employment Statistics

Employment and continuing education rate of 100 percent – 50 percent are employed; 50 percent continued their education.

Certification

Graduates are eligible to take national certification examinations offered by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). AHIMA offers Certified Coding Specialist (CCS) exams, and the AAPC offers Certified Professional Coder (CPC) exams. It is recommended students work for a minimum of one year full-time in a coding position before taking the CCS and CPC exams. 

Related Programs

Health Information Technology

Coding & Reimbursement Specialist - Certificate

Current Gainful Employment Data can be accessed online at: catalog.alfredstate.edu/current/programs/coding-reimbursement-specialist/

More information on jobs related to this program can be found at: www.online.onetcenter.org/link/summary/29-2071.00

TYPICAL FOUR-SEMESTER PROGRAM - Full-time

This program is offered as an Internet-based program only.

First

BIOL 1114 Human Anat & Physiology I 4
MEDR 1132 Essentials of Pharmacology 2
MEDR 1133 Medical Terminology 3
MEDR 1114 Intro to Health Info Managemnt 4
      13

Second

BIOL 2214 Human Anat & Physiology II 4
BIOL 4403 Pathophysiology 3
MEDR 1234 ICD-10-CM & ICD-10-PCS Coding 4
MEDR 3114 Electronic Health Record Mgmt 4
      15

Third

MEDR 1244 CPT & HCPCS Level II Coding 4
MEDR 4214 Insurance&Reimbursmt Processng 4
      8

Fourth

MEDR 2614 Advanced Coding & Reimbursemnt 4
MEDR 4322 Coding PPE 2
      6

Be advised that a prior felony conviction may impede a student’s ability to participate in a required professional practice experience.

GRADUATION REQUIREMENTS

C&RS students are required to earn a grade of a least a "C" or better in each BIOL and MEDR prefix course prior to placement in the PPEs. Students must also earn a grade of at "C" in the MEDR courses to graduate from the C&RS program.

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