Certified Professional Coder

Job Summary

The Certified Professional Coder is responsible for accurate coding of services performed in medical office, hospital, and outpatient surgical settings for physician and non-physician provider professional fees. The coder reviews provider documentation and supporting clinical records to assign and confirm diagnoses and procedures in the patient medical record using ICD-10-CM, CPT, and HCPCS Level II coding standards.

Key Responsibilities

• Review provider documentation to determine principal diagnosis, conditions, and surgical procedures.
• Assign ICD-10-CM diagnosis and procedure codes for Medicare and non-Medicare encounters.
• Assign ICD-10-CM and CPT procedure codes for outpatient procedures and surgical encounters.
• Sequence diagnosis and procedure codes correctly.
• Use coding principles and reimbursement knowledge to assign appropriate codes.
• Work Alpha II edits and support billing corrections.
• Assign discharge disposition for inpatient and observation encounters.
• Compile reports for incomplete records and monitor pending charge reports.
• Coordinate with the PBO team on billing and coding issues.
• Communicate with physicians to improve documentation accuracy.
• Process accounts according to the 2-3-day rule.
• Assist with RAC audits, denied claims, appeal letters, and medical necessity reviews.
• Support physician record review and charge description master coding as needed.
• Stay current on coding clinic and CPT assistant guidance.
• Maintain productivity, accuracy, confidentiality, and compliance standards.