The medical coding and reimbursement specialist (MCRS) reads and interprets the medical
records of patients in all types of health care facilities to obtain detailed information
regarding their diseases, injuries, surgical operations and other procedures. This
specialist then assigns codes using ICD-9-CM, ICD-10-CM/PCS, and CPT/HCPCS. They handle
all components of claims processing including management of disputed, rejected and
Students who successfully complete this program should be able to do the following
- Read and interpret medical records of patients.
- Accurately assign diagnostic and procedural codes according to ICD-9-CM, ICD-10-CM/PCS,
and CPT coding systems using federal coding compliance guidelines; review the coding
done on the encounter forms for accuracy.
- Use manual and computerized encoders and groupers systems to determine Diagnosis-Related
Groups (DRGs), Resource Based Relative Value Scale (RBRVS), and Ambulatory Payment
- Perform mathematical calculations for submitting insurance claims including deductible
amounts, allowed amounts, secondary insurance allowed amounts and patient's responsibility.
- Complete and electronically transmit insurance, CMS 1500 and UB 04 Medicare/Medicaid
- Post charge payments and write-offs on patient visits.
- Review returned, disputed or rejected claims from Medicare and another third party
payers, and problem solve.
- Respond appropriately to patients/family questioning medical bills.
- Act as a resource to patients, families, physicians, and office staff regarding insurance
coverage for specific procedures.
- Apply regulations for the release of confidential data, following HIPAA privacy requirements
- Schedule patient visits.
- Use personal computer software programs, as well as manual and automated accounting
- Thorough understanding of the content of the medical record in order to be able to
locate information to support or provide specificity for coding.
- Medical terminology, anatomy and physiology of the human body, disease processes,
and pharmacology in order to understand the etiology, pathology, symptoms, signs,
diagnostic studies, treatment modalities, and prognosis of diseases and procedures
to be coded. Simply locating diagnostic and procedural phrases in the coding books
without applying knowledge of disease processes and procedural techniques leads to
- Health care delivery systems, regulations, and political reform.
- Medical and dental reimbursement requirements and systems as well as forms completion
for Medicare, Medicaid, and private insurance programs.
- ICD-9-CM, ICD-10, CPT/HCPCS and CDT diagnostic and procedural coding systems, common
coding errors, and their impact on claims processing.
- Basics of manual and automated accounting systems and electronic claims transmission.
- Manual and computerized systems including health information management.
- Registration and scheduling of patients and clinicians, purchasing and monitoring
of office and medical supplies, and provider correspondence.
- Legal aspects of health care and confidentiality requirements including HIPAA privacy
and security regulations.
- Personal computer applications including word processing, spreadsheet basics, Windows,
hardware and file maintenance and other topics related to computers in health care.
- Oral and written communications using Standard English when clarifications are needed
with physicians and administrators.
The Medical Coding and Reimbursement Specialist program at Shoreline Community College
is approved by the American Health Information Management Association (AHIMA) as a
Comprehensive Medical Coding Program.
Graduates are eligible to write the American Health Information Management Association's
(AHIMA Certified Coding Specialist - Physician's Office (CCS-P) examination or the
entry level Certified Coding Associate (CCA) for hospital inpatient coding. They
are also eligible to write the American Academy of Professional Coders Certified Professional
Coding (CPC and CPC-H) examinations. The AHIMA mastery-level Certified Coding Specialist
(CCS) examination is also available, although it is recommended that individuals code
in the hospital setting for several years before taking this advanced credential.
Graduates can be employed by physician offices and clinics, medical group practices,
dental offices and clinics, managed care companies, insurance companies, hospitals
and other health care providers.
Click here for information on the curriculum.