Professional Coder

The Remote Professional Coder reviews, analyzes, and validates CPT and ICD-10 diagnosis codes and charges applied by providers to ensure compliance with federal and state regulations and insurance carrier guidelines. This role performs accurate coding of CPT and ICD-10 diagnosis codes and supports compliant charge processing in a remote setting.

Key responsibilities

• Review, analyze, and validate CPT, ICD-10 diagnosis codes, HCPCS, modifiers, and provider charges for compliance.
• Perform accurate and compliant coding of CPT and ICD-10 diagnosis codes.
• Apply knowledge of National Correct Coding Initiative (NCCI) edits and relative value units as appropriate.
• Meet established productivity and quality standards.
• Review denials, research them, and respond appropriately and in a timely manner.
• Perform audits as determined by management.
• Assist with application testing for identified coding workflows as needed.
• Attend staff meetings, department meetings, and other assigned meetings.
• Support professional development through webinars, workshops, and conferences when appropriate.
• Work collaboratively with people from different disciplines and varying technical expertise.
• Stay current on insurance products, policies, procedures, and state/federal mandates related to coding and documentation.
• Interact with providers and staff to support accuracy and specificity in documentation and coding.
• Perform other duties as assigned.