Description:
POSITION SUMMARY:
The Certified Physician Coder reviews, analyzes, and interprets physician documentation, operative and pathology reports, radiation oncology treatment records, and medical records to accurately assign CPT, HCPCS, ICD-10-CM diagnosis codes, modifiers, and other required billing information in accordance with coding guidelines, payer policies, and organizational standards. The Certified Physician Coder collaborates with physicians, clinical staff, and Revenue Cycle team to clarify documentation, resolve coding discrepancies, support accurate reimbursement, and maintain the integrity of coded data for billing, compliance, and reporting purposes.
CORE ESSENTIAL RESPONSIBILITIES:
- Review operative reports, pathology reports, physician documentation, radiation oncology treatment records, and medical records to accurately assign CPT, HCPCS, ICD-10-CM diagnosis codes, and modifiers.
- Analyze, code, and abstract clinical information to support accurate reimbursement.
- Ensure coding accuracy and completeness in accordance with AMA, CMS, NCCI, payer-specific guidelines, and organizational policies.
- Collaborates with healthcare providers to clarify documentation and resolve discrepancies.
- Supports the billing process by providing accurate coded information for claims submission in a timely manner.
- Educate providers and staff regarding coding requirements, documentation standards, and regulatory updates.
- Assists management to analyze data, identify issues and propose strategies for resolution of complex coding issues.
- Assist Accounts Receivable team with coding-related claim rejections, denials, and appeals.
- Collaborate with the Compliance Director as needed regarding any coding compliance related issues.
- Perform other duties as assigned to support departmental operations.
Requirements:
REQUIRED EDUCATION & EXPERIENCE
- High school diploma or equivalent required; associate degree in health information management or related field preferred.
- Minimum of five (5) years of physician-based coding experience required, oncology surgical and radiation oncology coding experience preferred.
- Ability to collaborate with healthcare providers to clarify documentation and resolve discrepancies
- Required: Current CPC (Certified Professional Coder) certification.
- Preferred: Specialty coding certifications, including Certified General Surgery Coder (CGSC), Certified Hematology and Oncology Coder (CHONC), and/or Radiation Oncology Certified Coder (ROCC), demonstrating advanced knowledge in radiation oncology and surgical coding.
REQUIRED CERTIFICATES, LICENSE OR REGISTRATION
- CPC (Certified Professional Coder) through AAPC
REQUIRED KNOWLEDGE, SKILLS OR ABILITIES
- Advanced knowledge of CPT and ICD-10 coding systems and medical terminology.
- Familiarity with surgical oncology, breast surgery, melanoma surgery, radiation oncology and physician based procedural coding preferred.
- Strong understanding of third-party payer requirements, reimbursement policies, and billing compliance guidelines.
- Strong analytical, problem-solving, and organizational skills.
- Ability to work independently while managing multiple priorities and deadlines.
- Proficiency in electronic medical records (EMR) and Practice Management System, with the ability to audit and correct coding for accuracy and completeness.