Coding & Reimbursement Specialist

Securing accurate and appropriate payment for health care services challenges 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 needed to assign the correct code for prompt and accurate reimbursement. C&RS professionals analyze patient records, assign ICD (ICD-9-CM, ICD-10-CM/ICD-10-PCS), CPT, and HCPCS codes to diagnoses, procedures, and health care services provided to patients for timely and accurate healthcare billing, reimbursement, and medical necessity.

Web-based programs are organized under the health information technology/medical records program (HIT program). This means that 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.

Alfred State's comprehensive coding certificate program offers individuals the opportunity to pursue a business-related career that is an essential part of the health care industry. Students who successfully complete the C&RS program are eligible to take the national certification examination to become a Certified Coding Specialist (CCS). Traditionally, Alfred State graduates have achieved a passing rate above the national average on certification exams.

Professional Practice Experience

Students complete non-paid professional practice experiences (PPEs) in the health information (coding) department of an acute care hospital (200 hours). PPE arrangements are made in consultation with each student so that a convenient location is selected. 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 College 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.

Once a PPE placement has been arranged, students are expected to contact the professional practice supervisor to arrange a schedule for attendance. Students may be required to attend an on-site orientation at the professional practice facility, which could be several days in length.