A certified coding specialist is skilled in classifying medical data from patient records.  They read and review medical documentation provided by physicians and other healthcare providers in order to obtain detailed information regarding their disease, injury, surgical operations, and other procedures.  They translate this data into numeric codes.  They consult classification manuals and then utilize computer software to assign the patient to one of several hundred “diagnosis-related groups” or DRGs.  These medical codes are used extensively for reimbursement of hospital and physician claims for Medicare, Medicaid, and insurance payments.  Certified coding specialists must ensure correct code selection for compliance with federal regulations and insurance requirements.   A certified coding specialist also prepares statistical reports for use by hospital administrators for planning, marketing, and other management purposes.  Government agencies also use this information to identify healthcare concerns critical to the public.

Areas of Specialization
Depending on the organization they are employed at, the certified coding specialist may specialize in one area of coding, such as radiology, dental, anesthesia, or pathology.   Certified coding specialists may also specialize in quality control or auditing by reviewing patient charts to ensure they receive quality care and hospital stays are consistent with Centers for Medicare and Medicaid (CMS) guidelines per the DRG fee schedule.    


Work Environment
Certified coding specialists may work in a large hospital, physician’s office, clinics, surgery centers, nursing homes, insurance companies, dental offices, home health agencies, consulting firms, coding and billing services, and government agencies.  Regardless of where they work, there will be little or no patient contact.  In some healthcare facilities, they may be in an office separate from the healthcare facility for which they are doing the coding.