Professional Coder

Professional Coder

A professional coder provides timely and accurate clinical and administrative data to ensure optimal reimbursement for services performed at acute care, inpatient, outpatient, urgent care, or physician offices. The role requires ICD
10CM
diagnosis, CPT‑4 coding, and charge entry, working closely with billing staff, practice managers and office personnel while maintaining high coding quality standards.

• Contribute to organizational success targets for patient satisfaction.
• Develop and maintain effective working relationships with HIM department staff, physicians, external customers, patients, and other staff.
• Adhere to coding rules for multiple specialties (neurosurgery, pediatric surgery, rehab, orthopedic, cardiology, etc.) ensuring high-quality coding based on documentation.
• Follow policies, procedures, and guidelines, while using analytical skills to review charts, interpret documentation, and apply codes.
• Ensure coding is completed on time and maintain work queues with reasonable turnaround times, including assisting with backlogs.
• Participate in HIM department and area‑specific meetings (professional coding, practice management, billing, specialty clinical areas, resident/physician meetings).
• Assist in achieving departmental, AR, and area‑specific goals.
• Enter charges for professional services in office and hospital settings.
• Support physicians, leadership, managers, and staff on coding and documentation related items; research topics, recommend solutions, and provide education.
• Develop training or educational materials.
• Perform E&M, procedural, or other coding audits for many professional settings and services.
• Identify solutions to problems and resolve issues related to coding.
• Share knowledge during training of new staff and serve as a resource to others.
• Engage in independent learning with a desire for continued personal and professional growth; stay current on coding updates and publications.
• Utilize numerous references to support technical decisions and clinical understanding of disease processes or procedures/tests performed.
• Maintain professional credentials.
• Provide written and oral feedback to providers on audits and education as required.
• Work independently, making sound decisions, analyzing issues, and solving problems.
• Assist CBO/Finance/Data/CMG and other departments with coding, billing, and reimbursement follow‑up.
• Ensure compliance with all legal requirements, including HIPAA and state regulations.
• Adhere to HIPAA Privacy and Security policies and department procedures.
• Participate in development and attainment of department and workgroup goals.
• Perform additional duties as assigned, such as working with students or developing policies and guidelines for clinical, billing, or coding information.

• Education/
  
  Experience:
  
  Certified Professional Coder (CPC) required or associate degree/certificate in medical curriculum with at least two years of professional coding experience.
• Professional coding or physician office setting experience preferred.
• Experience with ICD9/10CM and CPT‑4 coding books and references in a professional setting.
• Ability to work under stress, limited time constraints, frequent interruptions, and deadlines.
• Preferably two years of experience interpreting professional/physician remittance advice statements for major insurance payers across multiple specialties.
• Knowledge, Skills & Abilities:
  • Basic computer skills and ability to search online resources.
  • Knowledge of standard office equipment and software (EMR, email, Lotus Notes, Outlook, Word, Excel, Intelicode, Systoc, AAPC, etc.).
  • Understanding of medical terminology and anatomy.
  • Familiarity with third‑party payer coding and billing reimbursement.
  • Knowledge of ICD9/10CM diagnosis coding, CPT‑4 coding, and HCPCS coding guidelines.
  • Effective verbal and written communication skills.
  • Strong organizational and prioritization skills.
  • Problem‑identification and resolution abilities.
  • Interpersonal skills for working with diverse individuals and personalities.
  • Sound judgment based on guidelines, regulations, and policies.
  • Capacity to sit and look at a computer screen for long periods.
  • Flexibility to…