Ambulatory Professional Fee and Hospitalist Coder (On-Site, Hybrid, Remote)

NorthBay Healthcare Corporation•Napa, CA

About The Position

At Northbay Health, the Coder accurately translates medical procedures and diagnoses into ICD-10, CPT, and HCPCS codes in a timely manner for hospital-based services. The role applies approved coding classification systems and modifiers in accordance with AAPC/AMA CPT guidelines, American Hospital Association Coding Clinic guidance, ICD-10-CM CMS requirements, HCAI rules, and Northbay Healthcare coding guidelines. The Coder uses EHR, abstracting, encoding, and computer-assisted coding systems, and communicates with providers to clarify documentation and explain coding requirements. The position is full-time, day shift, Monday through Friday, with timing assigned according to business needs and leadership discretion. Work may be on-site, hybrid, or remote. Remote work requires a private, distraction-free home workspace for HIPAA compliance and high-speed internet exceeding 125 Mbps download speed. The employee must report to the office when required; failure to meet regulatory accuracy standards may result in a return to an in-office work environment. Web-camera training is used frequently for team engagement.

Requirements

Five or more years of continuous experience in multi-specialty professional-fee hospital and clinical coding.
Experience with electronic medical records is required.
One of the following credentials: Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).
Comprehensive knowledge and application of professional-fee E&M guidelines for physician inpatient coding and billing.
Knowledge of anatomy and physiology, medical terminology, disease processes, reimbursement methodologies (DRGs, HCCs, APCs), and current ICD-10-CM, CPT, and HCPCS coding conventions, rules, and guidelines.
Understanding of the clinical content of a health record.
Knowledge of insurance requirements and compliance guidelines for Medicare, PHP, WHA, Medi-Cal, workers' compensation, and commercial insurance.
Ability to work remotely with the self-discipline required to do so.
Ability to work under continual deadlines and handle incoming work with variable requirements.
Ability to work independently and in a team environment.
Ability and desire to meet performance metrics after training; idle time is monitored for this hourly-paid position.
Technical aptitude, including the ability to learn software and troubleshoot equipment.
Ability to sit for long periods, lift, push, or pull 5 pounds, and occasionally bend, stoop, crouch, and reach.
Ability to concentrate and maintain accuracy despite frequent interruptions.
Keyboarding skills.
Attendance and punctuality in accordance with established policies and procedures.
For remote work, a private, distraction-free home workspace and high-speed internet exceeding 125 Mbps download speed, or willingness to upgrade internet upon an offer.

Nice To Haves

High school graduate or equivalent is preferred.
Experience with an encoder system is preferred.
Knowledge of PCs, Cerner, and/or computer systems and programs is highly desired.
Proficiency with Microsoft Office, including Email, Word, and Excel.

Responsibilities

Independently code inpatient records and hospital-based physician, professional fee, surgical, and other services using appropriate CPT, ICD-10, and HCPCS codes.
Apply modifiers as appropriate to maximize reimbursement and reduce denials.
Review visit information and documentation, identify discrepancies, and query providers as needed to ensure data accuracy and integrity.
Use the EHR, abstracting systems, encoding systems, and computer-assisted coding systems to perform coding responsibilities.
Ensure coding is accurate and sequenced correctly in accordance with coding guidelines, government regulations, and payer requirements.
Maintain current knowledge of coding requirements and compliance guidelines relevant to assigned specialties and departmental needs.
Meet department productivity and quality standards.
Abstract designated demographic and physician data into the medical record abstracting system for internal and external regulatory reporting.
Provide physicians with documentation education and support to ensure coding assignments comply with regulatory requirements.
Collaborate with the Clinical Documentation Integrity (CDI) program as needed.
Respond to audit reviews and address findings in a timely manner.
Provide timely feedback to the Manager, Professional Fee Coding, about operational issues and escalate recurring concerns as appropriate.
Partner with Business Office staff to resolve billing and coding issues and correct pending diagnoses or suspended reports as needed.
Keep management and applicable departments informed about completed work, backlogs, physician education activities, and other assigned responsibilities using designated tracking tools.
Maintain required coding certification and pursue ongoing professional development through educational programs, seminars, and related learning opportunities.
Protect patient confidentiality and health information by adhering to HIPAA policies and procedures.
Comply with organizational policies and procedures, safety standards, Joint Commission standards, and applicable regulatory requirements.
Demonstrate Northbay Health's True North Values: Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
Report to the office as required and perform other duties and responsibilities as assigned.