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Professional Coder – Physician Professional Coder
Job Description:
- Responsible for accurately reviewing and assigning Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and ICD-10-CM codes for professional claims billed by Capital Health Medical Group (CHMG) for hospital and outpatient procedures
- Accurately applies official coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) for assignment of procedural and diagnostic codes
- Reviews procedure documentation for accurate assignment of ICD-10-CM diagnosis, current procedural terminology (CPT-4) codes and modifiers
- Ensures appropriate coding of evaluation and management services when applicable
- Meets or exceeds departmental accuracy and productivity standards
- Ensures compliance with national coding guidelines and Capital Health's policies for complete, accurate and consistent coding resulting in appropriate reimbursement and data integrity
- Fosters teamwork and collaboration
- Reviews CCI edits, MUE edits, LCD and NCD coverage before chart finalization
- Identifies documentation gaps or inconsistencies and escalate when clarification is required
- Collaborates with billing, charge review, and revenue integrity teams to prevent recurring issues
- Addresses professional coding pre-bill edits timely to ensure minimal days in DNFB
- Acts as a subject matter expert for professional coding
- Performs other duties as assigned
Requirements:
- High school diploma or equivalent
- Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC), or Certified Coding Specialist-Physician (CCS-P) certification required
- Associate's degree in health information management preferred
- Two years' experience in physician coding role preferred
- ICD-10-CM, CPT-4 and HCPCS coding experience preferred
- One year surgical coding experience preferred
- Excellent verbal and written communication skills
- Strong knowledge of surgical coding guidelines
- Knowledge of pathophysiology and disease processes
- Special Training: Physician coding and Training certification
- Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint
- Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge
- CPC-A, CPC, or CCS-P required
- Ability to work in environment using multiple EMR systems
- Ability to work collaboratively with others as well as independently
Benefits:
- Medical Plan
- Prescription drug coverage & In-House Employee Pharmacy
- Dental Plan
- Vision Plan
- Flexible Spending Account (FSA) - Healthcare
- FSA - Dependent Care
- Retirement Savings and Investment Plan
- Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
- Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
- Disability Benefits – Long Term Disability (LTD)
- Disability Benefits – Short Term Disability (STD)
- Employee Assistance Program
- Commuter Transit
- Commuter Parking
- Supplemental Life Insurance - Voluntary Life
- Spouse - Voluntary Life
- Employee - Voluntary Life
- Child Voluntary
- Legal Services
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Identity Theft Insurance
- Voluntary Pet Insurance
- Paid Time-Off Program
