Certified Coder-ProFee II

EvergreenHealth•Kirkland, WA

2d•Onsite

About The Position

This position abstracts, analyzes, and assigns ICD-10-CM, CPT, HCPCS codes and appropriate modifiers for evaluation and management (E/M), minor and major procedures, and diagnostic tests using computerized or manual systems. The role involves researching and resolving complex coding and reimbursement issues to ensure accuracy, quality, and integrity of coding and billing practices. The Certified Coder-ProFee II will communicate effectively with physicians, clinic leadership, and billing/coding teams regarding documentation improvement opportunities, code changes, and denial trends, while maintaining department-defined quality and productivity standards.

Requirements

High school diploma or G.E.D.
Current professional coding credential: AAPC (Certified Professional Coder [CPC], Certified Outpatient Coder [COC]), PMI (Certified Medical Coder [CMC]), or AHIMA (Certified Coding Specialist-Physician [CCS-P], Certified Coding Specialist [CCS], Registered Health Information Administrator [RHIA], Registered Health Information Technician [RHIT]), Certified Coding Associate CCA.
Minimum three years of coding experience with one year of coding experience in a surgical practice, or one year of coding experience and current AAPC specialty surgical certification.
Satisfactory completion of general and specialty specific coding skills assessment.
Proficient knowledge of medical terminology, ICD-10-CM, CPT, and HCPCS coding conventions.
Comprehensive knowledge of anatomy, physiology, and disease processes.
Expanded understanding of payer billing requirements.
Excellent written and verbal communication skills.
Must possess or achieve one of the following AAPC specialty surgical certification(s) within one year from hire or transfer into the position: (Certified Cardiology Coder [CCC], Certified Coding Associate [CCA, Certified Cardiovascular and Thoracic Surgery Coder [CCVTC], Certified Gastroenterology Coder [CGIC], Certified General Surgery Coder [CGSC], Certified Interventional Radiology Cardiovascular Coder [CIRCC], Certified Obstetrics Gynecology Coder [COBGC], Certified Ophthalmology Coder [COPC], Certified Orthopedic Surgery Coder [COSC], Certified Urology Coder [CUC]).

Nice To Haves

Five years coding experience in a surgical practice.

Responsibilities

Abstracts, analyzes, and assigns CPT, HCPCS and ICD-10-CM codes for professional services based on documentation in the medical record, primarily for E/M, major procedures and diagnostic tests, adhering to industry standards and EvergreenHealth policies.
Meets department productivity and accuracy standards.
Serves as a subject matter resource to physicians for complex surgical procedures.
Evaluates patient coding inquiries to determine coding accuracy based on documentation in the patient’s medical record.
Promotes a positive working relationship by effectively communicating with clinic managers regarding changes in the provider’s CPT code selection.
Evaluates and researches coding denials from payers to determine the appropriate action and drafts appeal letters regarding complex surgical procedures and bundling issues for Denial Management.
Identifies and reports trends of code changes, payer denials, missed revenue opportunities and/or compliance risks to clinic leadership.
Identifies and communicates documentation improvement opportunities to physicians and clinic leadership.
Provides coverage and backup for other coders as necessary to meet organizational goals.
Abstracts, analyzes, and assigns CPT, HCPCS and ICD-10-CM codes for professional services based on documentation in the medical record, primarily for E/M, minor procedures and diagnostic tests, adhering to industry standards and EvergreenHealth policies.
Promotes a positive working relationship by effectively communicating with clinicians and other support staff regarding changes in the provider’s CPT code selection.
Evaluates and researches coding denials from payers to determine the appropriate action and drafts appeal letters for Denial Management.
Identifies and reports trends of code changes, payer denials, missed revenue opportunities and/or compliance risks to the Professional Coding Supervisor.
Identifies and communicates documentation improvement opportunities to Professional Coding Supervisor.
Performs other duties as assigned.