Coder II - Professional Services Billing

The Professional Coder provides timely and accurate clinical coding and abstraction of inpatient and outpatient services to support compliant and optimized reimbursement, research, and performance improvement initiatives. This role is responsible for coding, abstraction, and charge entry for professional and facility services, including evaluation and management services, ancillary/diagnostic services, and behavioral health services.

Essential Functions

• Assign appropriate diagnosis, procedure, and evaluation and management codes in accordance with coding guidelines and departmental standards.
• Audit provider documentation for compliant coding practices and provide feedback when needed.
• Meet with providers to review documentation and coding guidelines as necessary.
• Capture charges accurately based on documentation and integrate charges and codes appropriately.
• Suggest additions to fee schedules when new procedures or supplies are identified.
• Use available resources to maintain quality and consistency in coding, abstraction, and charge entry.
• Query medical staff for documentation clarification to ensure coding compliance and accuracy.
• Recognize cases requiring medical necessity coverage diagnoses and apply Local Coverage Determination policies as needed.
• Assist Accounts Receivable Specialists with claim submission and payment questions.
• Help train new team members.
• Use applicable software to retrieve documentation, abstract data/codes, and manage work lists.
• Stay updated on program-specific changes.