Physician Practice Coder
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Job Description
Physician Practice Coder reviewing physician records, CPT/ICD-10 coding, and charge capture for a healthcare system. Analyzing claim denials and improving coding accuracy and billing compliance.
Responsibilities:
- Conduct CPT and ICD-10 coding reviews by examining each line item in physician medical records and charge sessions
- Perform chart audits to ensure correct coding and charge capture
- Review patient medical records and abstract medical data identifying diagnoses and procedures
- Code diagnoses, procedures, and modifiers using ICD-10-CM and CPT-4/HCPCS classification systems
- Sequence diagnoses, procedures, and complications according to applicable coding and regulatory guidelines
- Consult with the CDCI team and appropriate physicians or medical staff to clarify medical record information
- Review and respond to coding questions
- Ensure billed services are accurately coded
- Provide continual coding updates and research coding issues
- Review charts for documentation and signatures
- Analyze coding-related claim denials and determine underlying causes
- Perform detailed reviews of denied claims, medical records, charge sessions, payer information, and coding guidelines
- Identify denial trends and recurring patterns; perform root cause analysis
- Determine coding corrections and recommend resolutions for coding-related denials
- Work closely with revenue cycle stakeholders and provide feedback to providers
- Perform other duties as needed
Requirements:
- Associate Degree or direct work experience equivalent to at least 2 years
- CPC/CCS – Certified Professional Coder certification
- 2–5 years of experience required in a multi-specialty physician coding environment, including coding, compliance, and billing processes
- In-depth knowledge of medical terminology, ICD-10-CM, and CPT-4
- Basic knowledge of human anatomy, physiology, and pathology
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques
- Ability to maintain yearly coding credentials
- Knowledge of UHDDS, Official Guidelines for Coding and Reporting, Coding Clinic guidelines, Medicare, Medicaid, payer, and other regulatory guidelines
- Ability to maintain strict confidentiality of personal/health-sensitive information and comply with HIPAA rules and regulations
- Excellent organizational, multitasking, prioritization, follow-through, and timeline-management skills
- Accuracy and attention to detail
- Problem-solving ability using job knowledge and current policies/procedures
- Ability to work cooperatively with healthcare delivery teams and staff, handle frequent interruptions, adapt to workload and schedule changes, and respond quickly to urgent requests
Benefits:
- Medical, dental, vision, and pharmacy benefits
- Discretionary annual bonuses
- Merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
- Resources to support employee and family well-being
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