Professional Fee Coder - Radiology

At Northbay Health, the Professional Fee Radiology Coder is responsible for accurate and timely professional fee coding of radiology services based on provider documentation and applicable coding guidelines.

This role reviews radiology documentation and assigns appropriate CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, and modifiers for professional fee billing. The coder ensures coding accuracy, documentation integrity, medical necessity support, and compliance with CMS, AMA/CPT, NCCI, payer-specific requirements, and North Bay standards.

Requires strong knowledge of radiology terminology, anatomy and physiology, diagnostic imaging services, professional component coding, and the ability to work independently with high accuracy in any EHR or coding/billing platform.

• Reviews radiology reports and related clinical documentation and assigns accurate CPT/HCPCS and ICD-10-CM codes for professional fee radiology services within assigned work queues and service areas.
• Applies appropriate modifiers and professional component coding requirements based on documentation, service performed, payer requirements, and established departmental guidelines.
• Codes assigned diagnostic imaging services, which may include radiography, CT, MRI, ultrasound, mammography, nuclear medicine, PET, fluoroscopy, and other radiology services within departmental scope.
• Validates that documentation supports the procedure, diagnosis, medical necessity, and service billed; identifies documentation discrepancies or incomplete information requiring clarification.
• Applies current CPT, HCPCS, ICD-10-CM, NCCI, CMS, AMA, and payer-specific coding guidance to assigned radiology encounters.

• Reviews and resolves coding-related edits and work queue items within the current EHR/coding platform to support timely and accurate claim submission.
• Validates CPT/HCPCS, ICD-10-CM, and modifier accuracy and makes appropriate coding corrections prior to billing.
• Escalates documentation deficiencies, conflicting information, or coding questions through established provider query and departmental escalation processes.
• Identifies recurring coding, documentation, or workflow issues and communicates trends to Professional Coding leadership.

• Maintains coding accuracy and productivity in accordance with departmental standards and assigned turnaround times.
• Reviews available clinical documentation and coding resources to ensure complete, compliant professional fee coding of assigned radiology services.
• Maintains current knowledge of radiology coding changes, annual CPT/HCPCS and ICD-10-CM updates, payer guidance, and regulatory requirements.

• Communicates coding and documentation questions clearly and professionally with Professional Coding leadership, providers, and applicable Revenue Cycle partners.
• Participates in coding education, workflow updates, and department meetings as assigned.
• Supports identification of documentation opportunities that affect radiology coding accuracy, medical necessity, or claim submission.
• Assists with coding research and provides supporting references when escalating complex radiology coding questions.

• Ensures all work complies with CMS, AMA/CPT, NCCI, payer policies, HIPAA requirements, and North Bay standards.
• Maintains strict confidentiality and protects patient and organizational information in accordance with HIPAA and North Bay policy.
• Supports continuous improvement of professional fee radiology coding workflows, quality, and claim accuracy.

• Demonstrates and role models the North Bay True North Values:
• Nurture Care (Compassion)
• Own It (Accountability)
• Respect Relationships (Teamwork)
• Build Trust (Integrity)
• Hardwire Excellence (Excellence)
• Performs other duties as assigned.

Education:

Associate's or Bachelor's preferred.

Certification:
Requires one of the following credentials: CPC, CCS-P, CCS, or COC. Radiology-specific coding education or specialty certification preferred; additional specialty credentials may be required based on assigned radiology scope.

Experience:

Minimum 3 years of professional radiology coding experience. Demonstrated knowledge of professional fee radiology coding, including CPT/HCPCS, ICD-10-CM, modifiers, and professional component requirements. Strong knowledge of anatomy, physiology, medical terminology,…