Professional Coder

• 1. Reviews medical record documentation to determine appropriate ICD-10-CM codes for work identified for a coding review in accordance with official coding guidelines.
• 2. Reviews medical record documentation and reviews clinician charging to accurately select and/or validate the appropriate CPT codes and modifiers in accordance with official coding guidelines. This includes resolving coding edits, as applicable.
• 3. Maintains a minimum of 95% overall coding quality score in work that qualifies for a coding review in diagnostic, procedural, modifier code selection and other applicable fields.
• 4. Maintains the productivity expectations as defined by the department for the coding service line.
• 5. Participates and seeks out career development activities by reading journals, coding articles, researching procedures and/or disease processes to ensure appropriate code selection, regularly attends coding education sessions, and actively participates in learning circles
• 6. Reviews specialty specific denials and consults research needed to resolve.
• 7. Completes other coding related roles and responsibilities as assigned by the department manager.

EDUCATION

Bachelors degree preferred. Requires course work, preferably college level, in anatomy and physiology, medical terminology, pathophysiology, and disease process.

EXPERIENCE

Requires a minimum of 2 years of professional coding experience.

LICENSURE

CPC or CCS-P credential required or another professional coding designation through the Academy of Professional Coders (AAPC). CPC-As are not acceptable in this level of position.

SPECIAL SKILLS

Comprehensive knowledge of anatomy/physiology, medical terminology, ICD-10-CM, and CPT coding with the ability to acclimate and apply knowledge in a fast-paced virtual coding environment. Knowledge of professional E/M leveling preferred. Must possess excellent communications skills orally and in writing, strong critical thinking and reasoning skills, in addition to time management skills. Must be able to perform functions independently and under limited supervision.