Job Description:

• Responsible for accurately reviewing and assigning Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and ICD-10-CM codes for professional claims billed by Capital Health Medical Group (CHMG) for hospital and outpatient procedures
• Accurately applies official coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) for assignment of procedural and diagnostic codes
• Reviews procedure documentation for accurate assignment of ICD-10-CM diagnosis, current procedural terminology (CPT-4) codes and modifiers
• Ensures appropriate coding of evaluation and management services when applicable
• Meets or exceeds departmental accuracy and productivity standards
• Ensures compliance with national coding guidelines and Capital Health's policies for complete, accurate and consistent coding resulting in appropriate reimbursement and data integrity
• Fosters teamwork and collaboration
• Reviews CCI edits, MUE edits, LCD and NCD coverage before chart finalization
• Identifies documentation gaps or inconsistencies and escalate when clarification is required
• Collaborates with billing, charge review, and revenue integrity teams to prevent recurring issues
• Addresses professional coding pre-bill edits timely to ensure minimal days in DNFB
• Acts as a subject matter expert for professional coding
• Performs other duties as assigned

Requirements:

• High school diploma or equivalent
• Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC), or Certified Coding Specialist-Physician (CCS-P) certification required
• Associate's degree in health information management preferred
• Two years' experience in physician coding role preferred
• ICD-10-CM, CPT-4 and HCPCS coding experience preferred
• One year surgical coding experience preferred
• Excellent verbal and written communication skills
• Strong knowledge of surgical coding guidelines
• Knowledge of pathophysiology and disease processes
• Special Training: Physician coding and Training certification
• Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint
• Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge
• CPC-A, CPC, or CCS-P required
• Ability to work in environment using multiple EMR systems
• Ability to work collaboratively with others as well as independently

Benefits:

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA) - Healthcare
• FSA - Dependent Care
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance - Voluntary Life
• Spouse - Voluntary Life
• Employee - Voluntary Life
• Child Voluntary
• Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program