Certified Coder-ProFee II

Job Title

Wage Range: $28.83 - $46.14 per hour Remote in state of Washington only - Kirkland, WA Campus

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Description

Abstracts, analyzes, and assigns ICD-10-CM, CPT, HCPCS codes and appropriate modifiers for evaluation and management (E/M), minor and major procedures, and diagnostic tests by using either computerized or manual systems. Researches and resolves complex coding and reimbursement issues to ensure the accuracy, quality, and integrity of coding and billing practices. Effectively communicates with physicians, clinic leadership and billing/coding teams regarding documentation improvement opportunities, code changes, and denial trends. Maintains department defined quality and productivity standards.

Primary Job Duties

• Abstracts, analyzes, and assigns CPT, HCPCS and ICD-10-CM codes for professional services based on documentation in the medical record. Code assignment is primarily for E/M, major procedures and diagnostic tests and based on industry standards and EvergreenHealth policies.
• Meets department productivity and accuracy standards.
• Serves as a subject matter resource to physicians for complex surgical procedures.
• Evaluates patient coding inquiries to determine coding accuracy based on documentation in the patient's medical record.
• Promotes a positive working relationship by effectively communicating with clinic managers regarding changes in the provider's CPT code selection.
• Evaluates and researches coding denials from payers to determine the appropriate action and drafts appeal letters regarding complex surgical procedures and bundling issues for Denial Management.
• Identifies and reports trends of code changes, payer denials, missed revenue opportunities and/or compliance risks to clinic leadership.
• Identifies and communicates documentation improvement opportunities to physicians and clinic leadership.
• Provides coverage and backup for other coders as necessary to meet organizational goals.

In addition, performs the following primary duties of Certified Coder-ProFee I:

• Abstracts, analyzes, and assigns CPT, HCPCS and ICD-10-CM codes for professional services based on documentation in the medical record. Code assignment is primarily for E/M, minor procedures and diagnostic tests and based on industry standards and EvergreenHealth policies.
• Promotes a positive working relationship by effectively communicating with clinicians and other support staff regarding changes in the provider's CPT code selection.
• Evaluates and researches coding denials from payers to determine the appropriate action and drafts appeal letters for Denial Management.
• Identifies and reports trends of code changes, payer denials, missed revenue opportunities and/or compliance risks to the Professional Coding Supervisor.
• Identifies and communicates documentation improvement opportunities to Professional Coding Supervisor.
• Performs other duties as assigned.

License, Certification, Education or Experience

REQUIRED for the position: High school diploma or G.E.D Current professional coding credential: AAPC (Certified Professional Coder [CPC], Certified Outpatient Coder [COC]), PMI (Certified Medical Coder [CMC]), or AHIMA (Certified Coding Specialist-Physician [CCS-P], Certified Coding Specialist [CCS], Registered Health Information Administrator [RHIA], Registered Health Information Technician [RHIT]), Certified Coding Associate CCA Minimum three years of coding experience with one year of coding experience in a surgical practice, or one year of coding experience and current AAPC specialty surgical certification as outlined below. Satisfactory completion of general and specialty specific coding skills assessment Proficient knowledge of medical terminology, ICD-10-CM, CPT, and HCPCS coding conventions. Comprehensive knowledge of anatomy, physiology, and disease processes. Expanded understanding of payer billing requirements. Excellent written and verbal communication skills. Must possess or achieve one of the following AAPC specialty surgical certification(s) within one year from hire or transfer into the position: (Certified Cardiology Coder [CCC], Certified Coding Associate [CCA, Certified Cardiovascular and Thoracic Surgery Coder [CCVTC], Certified Gastroenterology Coder [CGIC], Certified General Surgery Coder [CGSC], Certified Interventional Radiology Cardiovascular Coder [CIRCC], Certified Obstetrics Gynecology Coder [COBGC], Certified Ophthalmology Coder [COPC], Certified Orthopedic Surgery Coder [COSC], Certified Urology Coder [CUC]).

DESIRED for the position: Five years coding experience in a surgical practice.

Benefit Information

At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans 457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits
• Cafeteria & Gift Shop Discount