Professional Surgical Coder - Otolaryngology (On-Site, Hybrid, Remote)

NorthBay Healthcare Corporation•Fairfield, CA

About The Position

At Northbay Health, the Professional Surgical Coder accurately and promptly translates medical procedures and diagnoses into ICD-10, CPT, and HCPCS codes for professional surgery charges in outpatient and inpatient settings. The role requires a strong understanding of medical terminology, coding guidelines, regulations, and proficiency with an EHR or encoder system. The coder communicates with providers by email, query, phone, or in person to discuss coding requirements and provide education. Work follows approved coding systems and applicable AAPC/AMA CPT Guidelines, American Hospital Association Coding Clinic guidance, ICD-10-CM CMS guidance, HCAI requirements, and NorthBay Healthcare coding guidelines. The coder independently reviews patient records and codes diagnoses and procedures to support accurate physician, professional-fee, and surgical billing and reimbursement while ensuring compliance. The role uses electronic health record, abstracting, encoding, and computer-assisted coding systems, maintains coding productivity and quality standards, supports providers and organizational teams with coding issues, and responds to audits. The position reports to the office as required; if regulatory accuracy standards are not met, a return to an in-office work environment may be required. This is a full-time, hourly-paid position working days Monday through Friday, with timing assigned according to business needs and leadership discretion. Remote work requires a private, distraction-free home workspace for HIPAA compliance and high-speed internet with download speeds above 125 Mbps, or willingness to upgrade. Web-camera training is used frequently for team engagement.

Requirements

High school graduate or equivalent preferred; college coursework is a plus.
Current certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Coding Specialist–Physician (CCS-P).
At least five years of professional-fee coding experience, including surgical coding in both inpatient and outpatient settings.
Experience in at least two of the following specialties: Podiatry, Otolaryngology, OB-GYN, Orthopedics, Neurosurgery, Urology, Vascular, Cardiology, Interventional Radiology, Gastroenterology/GI Endoscopies, or Cardiothoracic Surgery.
Medical records experience using an EMR is required.
Comprehensive knowledge and application of professional-fee surgical guidelines, including appropriate coding of assistants and co-surgeons.
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.
Demonstrated understanding of the clinical content of a health record.
Knowledge of and experience with PCs, Cerner, and/or computer systems and programs; Microsoft Office skills including email, Word, and Excel.
Comprehensive understanding of insurance requirements and compliance guidelines for Medicare, PHP, WHA, Medi-Cal, Workers’ Compensation, and commercial insurance.
Ability and desire to meet metrics after training; idle time is monitored for this hourly-paid position.
Technically savvy, with the ability to learn software and troubleshoot equipment as needed.
Ability and self-discipline to work remotely, when applicable.
Ability to withstand continual deadlines and work with variable requirements.
Ability to work independently and as part of a team.
Ability to sit for long periods and lift, push, or pull 5 pounds; occasional bending, stooping, crouching, and reaching are required.
Ability to concentrate and maintain accuracy despite frequent interruptions; keyboarding skills.
Attendance is an essential function of the job.
For remote work, must have a private, distraction-free home work area for HIPAA reasons and high-speed internet exceeding 125 Mbps download, or be willing to upgrade.

Nice To Haves

College coursework.
Experience with an encoder system.
Experience across all listed specialties is ideal.
Some leadership experience.

Responsibilities

Independently code patient records and professional surgery charges for accurate physician, professional-fee, and surgical billing and reimbursement.
Code diagnoses and procedures according to the current classification system for the patient encounter and applicable guidelines, regulations, and coding conventions.
Collect visit information, analyze documentation, identify discrepancies, and query providers as needed to ensure data accuracy and integrity.
Use electronic health record, abstracting, encoding, and computer-assisted coding systems to perform job functions.
Ensure codes are accurate and sequenced correctly, including applying relevant edit rules for assistant and co-surgeons.
Abstract designated demographic data into the medical record abstracting system for internal and external regulatory reporting.
Provide coding and documentation education to providers as needed.
Maintain department coding productivity and quality standards and meet applicable metrics.
Research complex or unusual coding cases and forward unresolved coding questions to the manager for review.
Keep current on coding requirements and compliance guidelines for assigned specialties and departmental needs.
Serve as an organizational resource for coding and data issues and provide timely feedback to the Manager, Professional Fee Coding about operational issues.
Escalate repeated or continuing problems to the manager and work with Business Office staff to resolve billing and coding issues.
Correct pending diagnosis or suspend reports as needed.
Respond to audit reviews and address audit results in a timely manner.
Keep the manager and appropriate departments informed about completed work, backlogs, physician training, and other assigned duties using tracking tools.
Maintain required certification and support professional growth through educational programs and seminars.
Maintain confidentiality of patient records and comply with HIPAA policies and procedures.
Comply with North Bay policies and procedures, safety standards, TJC standards, and other applicable regulatory requirements.
Demonstrate NorthBay True North Values: Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
Report to the office as required and perform other duties as assigned.