Professional Coder - FT - Day - Physician Professional Coders Remote

Capital Health (US)

3d•Remote

About The Position

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.

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.
Excellent verbal and written communication skills.
Strong knowledge of surgical coding guidelines.
Knowledge of pathophysiology and disease processes.
Physician coding and Training certification.
Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint.
Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge.
Ability to work in environment using multiple EMR systems.
Ability to work collaboratively with others as well as independently.

Nice To Haves

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.

Responsibilities

Reviews procedure documentation to assign accurate CPT-4 procedure codes and appropriate modifiers for procedures in the operating room, as well as complex procedures performed in a procedure room.
Validates provider selected ICD-10-CM diagnosis codes.
Analyzes provider documentation to ensure the appropriate provider assigned Evaluation and Management (E&M) codes for the procedural cases.
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.
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.
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.