Certified Coder - ProFee I

Abstracts, analyzes, and assigns ICD-10-CM, CPT, and HCPCS codes and appropriate modifiers for evaluation and management, minor procedures, and diagnostic tests using computerized or manual systems. The role researches and resolves coding and reimbursement issues to support accuracy, quality, and integrity in coding and billing practices. It also involves communication with clinicians and billing/coding teams regarding code changes and denials, while maintaining departmental quality and productivity standards.

Primary Duties

• Abstract and assign CPT, HCPCS, and ICD-10-CM codes for professional services based on medical record documentation.
• Code evaluation and management visits, minor procedures, and diagnostic tests in alignment with industry standards and EvergreenHealth policies.
• Meet department productivity and accuracy standards.
• Communicate effectively with clinicians and support staff regarding provider CPT code selection changes.
• Evaluate coding inquiries to determine coding accuracy based on patient medical record documentation.
• Research coding denials from payers and draft appeal letters for denial management.
• Identify and report trends involving code changes, payer denials, missed revenue opportunities, and compliance risks.
• Communicate documentation improvement opportunities to the Professional Coding Supervisor.
• Perform other duties as assigned.