The Physician Coder is responsible for reviewing, analyzing, and assigning accurate CPT, HCPCS, and ICD-10 codes for professional fee services documented in the medical record. This role ensures proper sequencing, modifier use, and place-of-service coding in compliance with governmental regulations, third-party payer policies, and corporate standards. The Physician Coder plays a key role in revenue cycle accuracy by identifying documentation gaps, ensuring coding integrity, and working collaboratively with internal teams to support physician coding compliance and reimbursement.
Essential Functions
- Assigns accurate CPT, HCPCS, and ICD-10 codes for professional services, procedures, diagnoses, and treatments based on provider documentation.
- Ensures compliance with governmental regulations, third-party payer policies, and corporate coding protocols, following National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs).
- Performs coding audits and quality reviews, verifying accuracy of documentation and identifying areas for provider education.
- Works coding-related claim edits, holds, and scrubs in the electronic billing system (e.g., Athena Collector), ensuring timely claim resolution and reimbursement.
- Collaborates with physicians, revenue cycle teams, and coding education staff, requesting clarification when necessary to ensure optimal documentation and compliance.
- Performs edit checks on coded data before transmittal, identifying and correcting errors as needed.
- Maintains strict confidentiality of patient records, provider information, and financial data, adhering to HIPAA and corporate compliance policies.
- Escalates documentation or coding issues to the coding education team for provider training and improved documentation practices.
- Assists in coding-related special projects, ensuring accurate reporting and analysis of coding data for operational improvement.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- H.S. Diploma or GED required
- Associate Degree in Health Information Management, Healthcare Administration, or a related field preferred
- 2-4 years of experience in physician coding, professional fee coding, or medical billing required
- Experience with multiple specialties, surgical coding, or high-volume professional fee coding preferred
- Strong knowledge of ICD-10, CPT, and HCPCS coding systems for physician/professional fee services.
- Understanding of modifier usage, place-of-service coding, and payer billing guidelines.
- Experience with electronic health records (EHR), coding software, and claim processing systems.
- Ability to identify documentation deficiencies and escalate for provider education.
- Familiarity with NCCI edits, LCD/NCD guidelines, and medical necessity requirements.
- Strong analytical and problem-solving skills, ensuring accurate coding and optimal reimbursement.
- Effective communication and collaboration skills, working with providers, revenue cycle teams, and compliance staff.
- Certified Coder-AHIMA or AAPC (CPC) required or
- CCS-Certified Coding Specialist (CCS-P) required
- Additional certifications such as Certified Evaluation and Management Coder (CEMC) or Registered Health Information Technician (RHIT) preferred
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