PB Coder III- ORTHO

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The Coder III is responsible for reviewing for physician services and interpreting physician documentation, CPT and diagnosis coding, coding claim edit, and coding denial management utilizing ICD-10-CM and CPT-4/HCPCS coding systems. Codes highly complex surgical, special procedures, observation records, inpatient records, medical, diagnostic, procedural, and/or recurring records within established productivity and coding accuracy guidelines. Highly complex surgeries may require research and reference checking to ensure accuracy of problematic coding.

Extracts pertinent information from clinical notes, operative notes, radiology reports, laboratory reports, (including Pathology), procedure records, specialty forms, etc. Determines complex code assignment pertinent to Emergency Room, observation, inpatient, outpatient, ambulatory surgery, and other ancillary services.

The Multispecialty Coder must possess a strong surgical specialty background in some of the following specialties:
Neurosurgery, Trauma, Ortho, Plastic Surgery, etc. Codes complex surgical, special procedures, observation records, inpatient records, medical, diagnostic, procedural, and/or recurring records within. Highly complex surgeries may require research and reference checking to ensure accuracy of problematic coding. Evaluates medical record documentation, paper charge, discharge disposition, ICD-10 and CPT coding to optimize reimbursement by ensuring that medical, diagnostic and procedural codes and other documentation accurately reflect and support the visit.

Compiles necessary documentation prior to coding review; when documentation is not available, performs the appropriate steps to obtain the necessary documentation per the department’s policies and procedures. Works independently to resolve issues, applying root cause analyses to determine steps required for timely resolution. Meets established productivity and accuracy standards. Demonstrate the ability to communicate effectively and professionally in interactions with physicians, management, and staff.

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, coding denials, quality management data edits and/or other errors identified through various auditing or billing process.

• Four (4) years of coding experience required, two (2) years of experience must be in a Surgical/Ancillary Diagnostic discipline or 1 year of experience with specialty coding certification in a Surgical/Ancillary Diagnostic discipline.
• Knowledge of CPT and ICD-10 coding conventions.

• Patient-Centered Care – Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families.
• Integrity & Accountability – Acts ethically, maintains…