Coder II, Profee

Responsibilities and qualifications

• Review all pertinent physician, nursing, and ancillary documentation in the medical record.
• Determine level of acuity, procedures performed, billable supplies, and diagnoses to substantiate medical necessity.
• Sequence codes to maximize reimbursement and address bundling issues.
• Apply modifiers as needed.
• Resolve LMRP/CCI edits and coding denials.
• Use computer applications and resources essential to the coding process.
• Maintain charge lag and coding productivity standards.
• Refer problem accounts to appropriate coding or management personnel.
• Identify incomplete documentation and create physician queries for missing clarification.
• Monitor and resolve coding edits and denials in a timely manner.
• Assign appropriate ICD and CPT codes using standard guidelines, coding clinics, and CPT Assistant resources.
• Review coding for accuracy and completeness prior to submission to the billing system.
• Maintain daily productivity statistics and submit weekly productivity sheets.
• Participate in monthly coding meetings and continuing education.
• High school diploma or equivalent required.
• Minimum 3 years of coding experience or CPC certification required if not using schooling-based experience.
• Graduate of an approved certified coding program preferred.
• Coursework in anatomy and physiology, pharmacology, pathophysiology, medical terminology, ICD-9-CM/ICD-10, and CPT coding guidelines preferred.
• Proficient computer skills, including MS Excel, preferred.
• Eligible for CPC or CPC specialty certification.
• Act 34 clearance required.