Certified Professional Coder

Incumbent reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid, and private insurance payments. Ensures compliance with established coding guidelines, third-party reimbursement policies, regulations, and accreditation guidelines.

Responsibilities

• Abstracts necessary information and assigns ICD-10, CPT, and HCPCS codes to accurately describe documented diagnoses, surgical procedures, and special therapies/procedures.
• Determines whether provider-documented diagnoses and procedures are valid and complete.
• Performs quantitative record analysis to ensure all required components are present, including patient identification, signatures, and dates where required.
• Evaluates documentation consistency and adequacy and reviews records for compliance with reimbursement agency rules and screening criteria.
• Assigns appropriate evaluation and management levels using the correct CPT code.
• Enters codes into the electronic health record and billing system and follows up on outstanding encounters.
• Conducts chart reviews and documentation audits, providing feedback and education to clinical providers and staff.
• Serves as a coding subject matter expert and answers coding and documentation questions.
• Queries providers when documentation or diagnoses need clarification.
• Participates in quality assurance, improvement, and control activities.
• Follows all department, Seneca Nation, and Seneca Nation Health System policies and procedures.