PB Coder II

Purpose

Responsible for coding and abstracting procedural (CPT) and diagnosis codes (ICD-10) for physician services, reviewing physician documentation in the electronic medical record for completeness and accuracy, ensuring proper code assignment, providing physician feedback of discrepancies/trends, resolving edits and denials, and releasing encounters for billing. Utilizes intermediate problem‑solving skills to address coding related tasks of detailed, medium complexity. Includes coding for all places of service, including ER, observation, inpatient, outpatient, ambulatory surgery and other ancillary services.

Monitors medical records to ensure documentation complies with hospital and payer policies and regulations. Educates physicians on proper documentation techniques and improvement opportunities. Maintains working knowledge of payer specific coding guidelines, medical terminology, modifier usage, NCCI edit conventions and billing and reimbursement guidelines. Ability to translate operative notes into billable services.

High School Diploma/GED required. Coding Certificate program, AAPC or AHIMA accredited preferred.

Two (2) years of coding experience required. Working knowledge of medical terminology, anatomy, physiology. Proficiency with Microsoft Office.

Preferred qualifications:

Knowledge of EPIC eMR, strong analytic skills, Computer Assisted Coding (CAC) knowledge.

• Codes office, hospital inpatient, outpatient, medical, diagnostic, procedural, emergency room and recurring records within established productivity coding accuracy guidelines.
• Evaluates medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the visit.
• Assigns and sequences codes accurately based on medical record documentation.
• Assigns the appropriate discharge disposition as necessary.
• Evaluates records and prepares reports of appropriate production metrics and coding feedback and maintains or exceeds established productivity and coding accuracy standards. May monitor unbilled accounts.
• Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes; offers physician opportunity to submit corrected documentation.
• Notifies appropriate individuals of potential non‑compliance with medical necessity requirements and when services are non‑covered or not payable, as appropriate.
• Corrects failed claim errors to billing edits, and other coding related errors.
• Documents coding information and takes appropriate actions in the Practice Management System in accordance with the department’s policies and procedures.
• Maintains the knowledge necessary to navigate the eEMR to efficiently perform tasks and meet production and quality standards. Works independently to resolve issues, applying root cause analyses to determine steps required for timely resolution.
• Provides technical guidance to physicians and other departmental staff in identifying and resolving issues or errors.
• Develops effective working relationships with physicians and other stakeholders. The ability to communicate effectively and professionally in interactions with physicians, management, and staff. Must be able to work collaboratively and positively within a culturally diverse production environment.
• Maintains professional growth by participating in educational programs and professional organization to stay abreast of code changes, trends, practices, and developments. Must meet all requirements to maintain coding certification.
• Performs other duties as assigned.

• Knowledge of ICD-10-CM and CPT coding principles and guidelines.
• Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system.
• Knowledge of reimbursement systems, as well as federal, state and payer‑specific regulations and policies pertaining to medical documentations, billing and coding.
• Knowledge of Standards of Ethical Coding.
• Skill and ability to communicate effectively both orally and in writing.
• Skill and ability to research and analyze data, draw conclusions, and resolve issues.
• Skill and ability to read, interpret and apply policies, procedures, laws, and regulations; prepare reports and related documents.
• Skill and ability to maintain working relationships with physicians and staff.
• Skill and ability to review the work of others and maintain confidentiality.