Position Summary / Career Interest:

The Physician Coder is responsible for reviewing outpatient/inpatient EHR. This position monitors CPT, ICD-10, and HCPCS code changes. Codes CPT, HCPCS, and diagnosis for Primary Care/Medical Specialty/Non-Surgical accounts using ICD-10 nomenclature. The Physician Coder is resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician billing.

Responsibilities:

• Reviews outpatient/inpatient EHR for appropriate documentation and signatures, and reviews interface charges prior to billing.  Reviews departmental reporting structures and requests modifications as needed, i.e. adding billing areas, providers, etc.  Monitors CPT, ICD-10, and HCPCS code changes.  Codes CPT, HCPCS, and diagnosis for Primary Care/Medical Specialty/Non-Surgical accounts using ICD-10 nomenclature.  After completion of two years of coding trains on specialty/surgical coding.
• Reviews coding by physicians and suggest possible modification of codes to maximize reimbursement as allowed by coding and payer guidelines in accordance with supporting documentation.  Reviews reimbursement from third-party payers to ensure payment through proper use of codes.
• Identifies and resolves potentially troublesome service/billing areas such as continuity of care, discharge summaries, admission history and physicals and consultations.
• Resolves all coding related edits and denied claims.
• Communicates pertinent information on appropriate documentation to physicians and staff.
• Maintains knowledge of requirements for appropriate charge generation.
• Identifies and codes for all diagnoses documented supported within clinical documentation.  Captures unspecified diagnoses used and determine if documentation supports a more specific diagnosis
•  Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to inpatient and outpatient diagnoses and procedures.
• Consults with and educates/trains physicians on coding practices and conventions in order to provide detailed coding information.
• Communicates with nursing and ancillary services personnel for needed documentation for accurate coding.
• Must be able to meet productivity requirements as outlined by clinical specialty and hospital quality requirements of 95% or better after training has concluded.

* Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.

* Note:  These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.  Skills and duties may vary dependent upon your department or unit.  Other duties may be assigned as required.

Required:

• High school diploma or GED
• At least one of the following certifications is required: CPC, COC, CIC, CCA, CPC-A Certification

Preferred:

• Epic experience

• Associate's Degree in related field

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.