Professional Coder-Certified

CENTERS FOR PAIN CONTROL•Valparaiso, IN

3d•Onsite

About The Position

Reporting to the Billing Team Supervisor, the professional coder is responsible for reviewing clinical documentation to abstract and/or validate CPT and ICD-10 coding for office based and outpatient professional services. This role involves training new employees, conducting audits to ensure accuracy, monitoring daily workloads, and ensuring timely claim creation. The coder will analyze medical records to assign accurate ICD and CPT/HCPCS codes, resolve coding-related edits, and maintain compliance with regulations. They will also serve as a subject matter expert, stay updated on coding changes, assist with coding denials and appeals, and contribute to charge capture initiatives. The position requires monitoring claim worklists, attending meetings and training sessions, and developing personal and professional skills. Behavioral expectations include striving for excellence, meeting customer needs, working effectively in a team, and being self-directed.

Requirements

Knowledge of Electronic Medical Record
Good typing skills
Good internet navigation skills
Knowledge of instrumentation used in office (fax, credit card, copy)
Knowledge of multi-line phone system
Excellent Verbal and Written Communication skills
Knowledge of medical terminology with a strong focus on the spine and skeletal system.
Advanced knowledge and skill in CPT, ICD-10-CM and HCPCS code assignment
Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing, with demonstrated ability to interpret such guidelines
5 years of experience with research, analyze, interpret, and abstract data/documentation
Ability to collaborate with cross functional teams and departments
Good problem-solving skills
Certified Professional Coder (CPC) or Certified Coding Specialist-Physician based (CCS-P) preferred
High School diploma or equivalent
5 years of professional coding experience in a physician practice setting.
2 years of current direct supervisory experience as a Billing/Coding/Reimbursement Supervisor with assigned direct reports
5 years of experience with ICD-10, CPT and HCPCS.
5 years of experience in medical terminology.
5 years of experience of Explanation of Benefits and CMS 1500 form.

Nice To Haves

Certified Professional Coder (CPC) or Certified Coding Specialist-Physician based (CCS-P)

Responsibilities

Train new employees on coding procedures.
Perform ongoing training and education for the coding team.
Conduct audits to ensure the accuracy of the coding team and provide re-training or coaching as needed.
Monitor daily workload to ensure timely creation of claims.
Ensure professional and facility service claims are created daily without interruption.
Analyze office progress notes, procedural and operative records to identify and assign accurate ICD and CPT/HCPCS codes.
Adhere to ICD-10-CM, CPT, and all appropriate government coding guidelines, as well as CPC/IPM coding/billing policies and procedures.
Resolve coding-related edits in the AthenaOne practice management system.
Abstract pertinent information into the billing system accurately and timely.
Maintain compliance with Federal, State, and Payer regulations.
Serve as a subject matter expert to the coding team and clinicians.
Keep abreast of current coding changes, documentation requirements, and payer policies within designated specialties.
Educate/train coding staff, physicians, and mid-level providers.
Assist with coding denials received from payers.
Identify denial trends and educate the coding team or request system edits.
Appeal claims as needed and assist with the development of letters of medical necessity.
Assist with charge capture initiatives by monitoring services performed to assure all encounters are captured, coded, and billed within established timeframes.
Monitor AthenaOne claim worklists to ensure charges are worked timely and alert management if concerns are identified.
Attend meetings and training sessions virtually or by traveling as needed.
Develop and maintain personal and professional skills.
Attend all mandatory staff meetings and in-services.
Actively participate in performance improvement activities.
Establish realistic professional goals.
Keep abreast of departmental and organizational activities.
Demonstrate flexibility in response to unexpected changes.
Serve on committees and/or participate in changes of policy and procedures affecting the revenue cycle.
Assist in the orientation of new personnel.
Support the mission and goals of the company.
Address all emails within 24 hours.
Perform other duties as required.
Demonstrate safe and cost-effective practice.
Consistently adhere to OSHA bloodborne pathogen guidelines and apply universal precautions.
Consistently utilize proper body mechanics.
Accurately complete incident reports and communicate critical incidents.
Consistently allocate resources to reduce waste and minimize costs.
Consistently complete assigned duties within stated shifts in a timely manner.
Strive for excellence, set challenging goals, and produce quality work.
Maintain current knowledge and skill.
Participate in quality and process improvement efforts.
Keep the work area clean, safe, and secure.
Adapt to change, change plans and objectives given new direction or priorities, and handle stressful situations effectively.
Meet internal and external customers’ needs, find new ways of satisfying customers, participate in service improvement efforts, listen and respond to customers, and treat customers with compassion and respect.
Work as a team player, pitch in to help those in need, communicate appropriately, listen and respond to others, handle conflict situations effectively, and foster trust and respect within the team.
Foster diversity in the workforce by treating all associates and customers with respect, integrity, and dignity regardless of background.
Treat all associates and customers fairly.
Take initiative and responsibility for actions.
Identify own learning needs and create/implement Learning Plans.
Perform duties according to policies and procedures.
Demonstrate ethical behaviors.
Maintain confidentiality of information.
Maintain licenses and certifications as appropriate.
Fulfill operating unit/clinical competencies.
Use equipment/resources responsibly.