Physician Coder

Under the general supervision of the Coding Manager, this position is responsible for converting diagnoses and procedures for professional claims into codes using the appropriate code set. The Physician Coder ensures encounters are coded accurately and in a timely manner while working closely with physicians and allied health professionals to translate clinical documentation into ICD-10-CM, CPT, and APC codes.

Key responsibilities include:

• Assign diagnosis codes, procedure codes, modifiers, and charge levels using ICD-10-CM, CPT, and HCPCS codes based on provider documentation.
• Query providers when documentation is conflicting or ambiguous and request clarification before assigning unsupported codes.
• Monitor documentation turnaround time and productivity, and follow up on uncoded accounts or with providers and clinical staff as needed.
• Ensure medical record documentation and diagnoses are complete and valid prior to final coding.
• Provide coding and classification education to clinicians and share official coding guidelines as needed.
• Follow inpatient and outpatient professional coding compliance plans, official coding guidelines, and ethical coding standards.
• Maintain established productivity and accuracy standards.
• Perform other related duties as assigned.
• Follow fire, disaster, and safety procedures and regulations applicable to the work area.