Job Summary: The Certified Professional Coder is accountable for ensuring coding compliance for services performed by physicians and non-physician providers (e.g., nurse practitioners and physician assistants) and adhering to government regulations and coding guidelines. This position requires current, in-depth knowledge of coding governmental and commercial rules and regulations, including regulatory compliance requirements. 

Specific Tasks/Duties Include:

• Perform physician/non-physician provider documentation audits for compliance and regulatory requirements.
• Perform coding data audits to validate documentation supports services rendered for reimbursement and reporting purposes.
• Perform medical record review to abstract information required to support accurate coding for professional provider encounters.
• Identify documentation deficiencies and properly query providers for proper code capture.
• Partake in educating and training providers and other professionals in appropriate coding
• Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors.
• Assigns accurate CPT, HCPCS, and ICD medical codes for diagnoses and procedures.
• Ensure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Code review for medical necessity, claims denials, billing issues, and charge capture.
• Assist in the development and implementation of policy and procedures for the understanding of how to integrate medical coding and payment policy changes into the practice's reimbursement processes.
• Assist in the integration of coding and reimbursement rule changes and updating the Charge Description Master (CDM), including the appropriate application of modifiers.
• Assist in regular, weekly/monthly meetings with departmental site directors and medical directors and provides information related to coding review findings and regulatory coding updates.
• Serves as resource and subject matter expert to other staff.
• Provides ongoing support and training on all aspects of medical coding.
• Other duties as assigned by Director of Revenue Cycle.