Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.
The listed pay range or pay rate reflects compensation for a
full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
Pay Range:
$25.49 - $33.16
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.
Experience: Two years' experience in physician coding role preferred. ICD-10-CM, CPT-4 and HCPCS coding experience preferred. One year surgical 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.
Special Training: Physician coding and Training certification. Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint. Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge. CPC-A, CPC, or CCS-P required.
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
Reporting Relationships
Does this position formally supervise employees? No
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.
Meets 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.
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.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Minimal Color Discrimination, Accurate Depth Perception, Accurate Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
This position is eligible for the following benefits:
- Retirement Savings and Investment Plan
- Disability Benefits - Short Term Disability (STD)
- Sick Time Off
- Employee Assistance Program
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.
