Certified Professional Coder

Job purpose

• The certified coder prepares and submits clean claims to insurance companies electronically and by paper, and provides appropriate coding for each patient’s medical history, diagnosis, tests and treatment plan.

Duties and responsibilities

• Primarily codes from final office visit, surgical/procedural operative reports signed by providers
• Reviews medical records and accurately code primary and secondary diagnoses using CPT, ICD-9 and ICD-10 conventions; sequence the diagnoses and procedures using coding guidelines
• Verifies accuracy and submits claims to insurance using Electronic Medical Records systems and paper claims
• Enters patient copayment information into the EMR
• Reconciles charges against the schedule list to ensure no charges are missed
• Investigates rejected claims to see why denials were issued as necessary
• Re-bills rejected claims in timely manner
• Maintains strict confidentiality and high degree of accuracy
• Consults classification manuals and relies on knowledge of disease processes
• Correlates information from supporting clinical documentation when appropriate
• Communicates with clinical, ancillary services and medical personnel for needed documentation
• Provides feedback to providers as it pertains to proper coding and clinical documentation
• Keeps staff members informed of regulatory changes and updates
• Identifies and participates in educational opportunities for self
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
• Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance
• Adheres to Advanced Pain Care’s Policies and procedures
• Performs other duties as assigned

Qualifications

Education: Requires a high school diploma or GED; current CPC certification required

Experience: 

Prior medical coding experience required; must be familiar with correct billing techniques, CPT, ICD-9, ICD-10 coding, electronic medical records and strong knowledge of medical terminology.

Knowledge, Skills and Abilities:

• Extensive knowledge of coding in-office and surgical procedures and applicable modifiers
• Advanced knowledge of ICD-9-CM & CPT-4 coding conventions
• Knowledge of Anatomy and Physiology
• Knowledge of Medical Terminology
• Knowledge of EMR systems and Microsoft software applications
• Effective written and verbal communication skills
• Data entry skills and ability to type 50+ wpm
• Proficient in using 10 key and doing basic arithmetic
• Ability to maintain patient confidentially and comply with HIPAA guidelines
• Time management skills and ability to work efficiently to complete tasks
• Excellence in customer service

Working conditions

Environmental Conditions: Medical Office environment

Physical Conditions:

• Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
• Must be able to sit and/or stand for prolonged periods of time
• Must be able to bend, stoop and stretch
• Must be able to lift and move boxes and other items weighing up to 30 pounds.
• Requires eye-hand coordination and manual dexterity sufficient to operate office equipment