Professional Coder - FT - Day - Physician Professional Coders Remote (NJ, PA, AL)
Position Overview
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.
Minimum Requirements
- Education: High school diploma or equivalent.
- Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC), or Certified Coding Specialist-Physician (CCS-P) certification required.
- Associate's degree in health information management preferred.
- Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC), or Certified Coding Specialist-Physician (CCS-P) certification required.
- Experience: Two years' experience in physician coding role preferred.
- IDC-10-CM, CPT-4 and HCPCS coding experience preferred.
- Surgical coding experience preferred.
- IDC-10-CM, CPT-4 and HCPCS coding experience preferred.
Other Credentials
- Knowledge and Skills: Excellent verbal and written communication skills. Strong knowledge of surgical coding guidelines. Knowledge of pathophysiology and disease processes.
- Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint. Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge.
Special Training
- Physician coding and Training certification.
- Knowledge of official coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS).
Mental, Behavioral and Emotional Abilities
- Ability to work in environment using multiple EMR systems. Ability to work collaboratively with others as well as independently.
- Usual Work Day: 8 Hours
Physical Demands and Work Environment
- Frequent Physical Demands Include Occasional physical demands include: Standing, Walking, Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion, Taste or Smell, Talk or Hear.
- Continuous physical demands include: Sitting.
- Lifting Floor to Waist 15 lbs.
- Lifting Waist Level and Above 10 lbs.
- Lifting Floor to Waist 15 lbs.
- Continuous physical demands include: Sitting.
- Anticipated Occupational Exposure Risks Include the following: N/A
Reporting Relationships
- This position does not formally supervise employees.
- If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.
Essential Functions
- 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.
- Mets 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.
- Acts as a subject matter expert for professional coding.
- Addresses professional coding pre-bill edits timely to ensure minimal days in DNFB.
- Collaborates with billing, charge review, and revenue integrity teams to prevent recurring issues.
- Identifies documentation gaps or inconsistencies and escalate when clarification is required.
- Reviews CCI edits, MUE edits, LCD and NCD coverage before chart finalization.
- Fosters teamwork and collaboration.
- 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.
- Ensures compliance with national coding guidelines and Capital Health's policies for complete, accurate and consistent coding resulting in appropriate reimbursement and data integrity.
- Mets or exceeds departmental accuracy and productivity standards.
Benefits
- Medical Plan
- Prescription drug coverage & In-House Employee Pharmacy
- Dental Plan
- Vision Plan
- Flexible Spending Account (FSA)
- Healthcare FSA
- Dependent Care FSA
- Healthcare FSA
- Retail Savings and Investment Plan
- Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
- Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
- Disability Benefits – Long Term Disability (LTD)
- Disability Benefits – Short Term Disability (STD)
- Analyzes provider documentation to ensure the appropriate provider assigned Evaluation and Management (E&M) codes for the procedural cases.
- Employee Assistance Program
- Commuter Transit
- Commuter Parking
- Commuter Transit
- Supplemental Life Insurance
- Voluntary Life
- Spouse Voluntary Life
- Employee Voluntary Life
- Child
- Employee Voluntary Life
- Spouse Voluntary Life
- Voluntary Life
- Voluntary Legal Services
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Identity Theft Insurance
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Pet Insurance
- Paid Time-Off Program
- Validates provider selected ICD-10-CM diagnosis codes.
Pay Range
The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.