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

NorthBay Health•Fairfield, CA

3d•$42 - $51

About The Position

The Professional Surgical Coder accurately translates medical procedures and diagnoses into ICD-10, CPT, and HCPCS codes for professional surgery charges in outpatient and inpatient settings. The role requires knowledge of medical terminology, coding guidelines and regulations, and proficiency with EHR and encoder systems. The coder communicates with providers by email, query, phone, or in person to discuss coding requirements and provide education. Work follows applicable AAPC/AMA CPT Guidelines, AHA Coding Clinic guidance, ICD-10-CM and CMS requirements, HCAI requirements, and NorthBay Healthcare coding guidelines. The role independently codes patient records for accurate physician, professional-fee, and surgical billing and reimbursement while maintaining compliance. It involves reviewing documentation, identifying discrepancies, querying providers, ensuring correct code sequencing, abstracting required data, resolving billing and coding issues, responding to audits, maintaining productivity and quality standards, and keeping coding knowledge current. The coder serves as an organizational resource, reports operational concerns and work status to the Manager, Professional Fee Coding, and maintains required certification and HIPAA confidentiality. The position is full-time, days, Monday through Friday, as assigned, with timing subject to leadership discretion and business needs. On-site, hybrid, or remote work may be available depending on business needs. Remote work requires a private, distraction-free home workspace for HIPAA compliance and high-speed internet exceeding 125 Mbps download speed. Frequent webcam use is expected for team engagement and training. The role may require returning to an in-office environment if regulatory accuracy standards are not met.

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).
Five or more 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.
Experience with electronic medical records is required.
Comprehensive knowledge and application of professional-fee surgical guidelines, including appropriate coding of assistants and co-surgeons.
Demonstrated 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 PC use, Cerner and/or computer systems and programs, and Microsoft Office applications including email, Word, and Excel.
Comprehensive understanding of insurance requirements and compliance guidelines for Medicare, PHP, WHA, Medi-Cal, Workers’ Compensation, and commercial insurers.
Ability and desire to meet metrics after training; idle time is monitored for this hourly-paid position.
Technological aptitude, including ability to learn software and troubleshoot equipment.
Ability and self-discipline to work remotely.
Ability to manage continual deadlines and work with variable requirements.
Ability to work independently and as part of a team.
Adherence to established policies and procedures, including attendance and punctuality standards.
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.
Must have a private, distraction-free home work area for HIPAA reasons if working remotely.
Must have high-speed internet with download speed over 125 Mbps for remote work, or be willing to upgrade upon an offer.

Nice To Haves

Some leadership experience is preferred but not required.
Experience with an encoder system is preferred.
Experience across all listed specialties is ideal.

Responsibilities

Independently code patient records to support accurate physician, professional-fee, and surgical billing and reimbursement while ensuring compliance.
Code diagnoses and procedures according to the current classification system and the type of patient encounter.
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 under coding guidelines and government and insurance regulations, including edit rules for assistant and co-surgeons.
Abstract designated demographic data into the medical record abstracting system for internal and external regulatory reporting.
Provide providers with coding and documentation education as needed.
Maintain department coding productivity and quality standards.
Research complex or unusual coding cases and forward unresolved questions to the manager for review.
Keep knowledge of coding requirements and compliance guidelines current for assigned specialties and departmental needs.
Serve as a resource for coding and data issues across the organization.
Provide timely feedback to the Manager, Professional Fee Coding, identify operational issues, and escalate repeated or continuing problems.
Work with Business Office staff to resolve billing and coding issues and correct pending diagnosis or suspend reports as needed.
Respond to audit reviews and address audit results promptly.
Use provided tracking tools to keep the manager and appropriate departments informed about completed work, backlogs, physician training, and other assigned duties.
Maintain required certification and pursue professional growth through educational programs and seminars.
Maintain HIPAA confidentiality for patient records and comply with NorthBay policies and procedures, safety standards, TJC standards, and other applicable regulations.
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 as assigned.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
Disability insurance
Long-term care coverage
Paid time off, including vacation, sick leave, holidays, and bereavement
403(b) retirement plan with employer match
Education reimbursement for eligible roles
Professional development and training programs
Employee Assistance Program
Wellness programs
Recognition programs
Shift differentials
Market-based compensation review and increases subject to approval and organizational performance