Ambulatory Professional Fee and Hospitalist Coder (On-Site, Hybrid, Remote)

Job Description

Job Description

At Northbay Health, the Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner in the hospital setting. Our ideal candidate is a dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Abstracts demographic and physician data to meet both internal and regulatory requirements for reporting utilizing the hospital’s abstracting system. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and Northbay Healthcare coding guidelines.

Primary Job Duties

• Independently performs coding of patients’ inpatient records to ensure accurate assignment of physician, professional fee, surgical, and other hospital-based services using the most appropriate CPT, ICD-10, and HCPCS codes in accordance with CMS, Coding Clinic, and other regulatory guidelines. Adds modifiers as appropriate to maximize reimbursement and reduce denials.
• Must have experience working in a multi-specialty environment and assigning physician Evaluation and Management (E&M) levels.
• Collects visit information, analyzes documentation, identifies discrepancies, and queries providers as needed to ensure the accuracy and integrity of reviewed data.
• Utilizes the electronic health record (EHR), abstracting systems, encoding systems, and computer-assisted coding systems to perform job responsibilities.
• Ensures coding is accurate and sequenced correctly in compliance with coding guidelines, government regulations, and payer requirements.
• Maintains current knowledge of coding requirements and compliance guidelines based on assigned specialty and departmental needs.
• Meets department productivity and quality standards for coding performance.
• Abstracts designated demographic data into the medical record abstracting system to satisfy internal and external regulatory reporting requirements.
• Provides documentation education and support to physicians to ensure coding assignments comply with regulatory requirements.
• Collaborates with the Clinical Documentation Integrity (CDI) program as needed.
• Responds to audit reviews and addresses findings in a timely manner.
• Provides timely feedback to the Manager, Professional Fee Coding, regarding operational issues and escalates recurring concerns as appropriate.
• Partners with Business Office staff to resolve billing and coding issues and corrects pending diagnoses or suspended reports as needed.
• Keeps management and applicable departments informed regarding completed work, backlogs, physician education activities, and other assigned responsibilities through designated tracking tools.
• Maintains required coding certification and pursues ongoing professional development through educational programs, seminars, and related learning opportunities.
• Adheres to HIPAA policies and procedures to maintain patient confidentiality and protect all health information.
• Complies with organizational policies and procedures, safety standards, Joint Commission (TJC) standards, and all applicable regulatory requirements.
• Demonstrates the True North Values of Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
• Reports to the office as required and understands that failure to meet regulatory accuracy standards may result in a return to an in-office work environment.
• Performs other duties and responsibilities as assigned.