PFS - Coder

General Summary

The PFS Medical Coder is responsible for the transformation of healthcare diagnoses, procedures, medical services, and equipment into universal alphanumeric codes. The coder assigns and verifies the correct codes used to describe the type of service(s) the patient received. The coder ensures codes are applied correctly during the medical billing process, which includes removing information from documentation, assigning appropriate codes, and creating a claim to be paid by insurance carriers.

Coders work with hospitals, clinics, and physician offices as needed to provide personalized, professional healthcare services to the communities we serve.

• Assign codes to diagnoses and procedures using ICD-10, CPT, and HCPCS codes.
• Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations.
• Know and understand how to properly code using medical coding books.
• Follow up with the provider on any documentation that is insufficient or unclear.
• Ensure that all codes are current and active.
• Ensure appropriate, accurate/timely follow‑up is taken on all denials and rejections received.
• Adequately respond to coding questions and provide clarification to colleagues.
• Develop and maintain appropriate communication with clinics.
• Appropriately refer all non‑routine issues to management for clarification.
• Re‑code and reprocess all denials and rejections ensuring all avenues are explored to resolve issues with insurance payers.
• Work with fellow staff in a professional, courteous and respectful manner at all times.
• Monitor CPTs and diagnoses to assure they are coded correctly prior to billing.
• All other duties assigned by the Director of PFS or Executive Director of Revenue Cycle.