Position Summary

The Certified Procedural Coding Specialist will read and interpret health record documentation to identify all  diagnoses and procedures that affect the current inpatient/outpatient encounter visit; assess the adequacy of health record documentation; apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures.

Work Schedule

Monday – Friday, 8-5 or as determined by supervisor

Primary Duties

Essential Functions:

• Codes and abstracts all diagnoses and procedures from physicians’ dictation and according to ICD-10-CM and CPT-4/HCPCS.
• Processes claims for secondary insurance companies and conducts research on any claims denied by insurance companies.
• Initiates physician interaction when ambiguous or conflicting information is in the medical record.
• Exhibits knowledge and aptitude regarding coding software and resources for accurate code assignment
• To assist medical providers in using the appropriate ICD-10 code, check insurance status, bill insurance appropriately, fight denials, and reduce A/R.
• Correctly performs routine billing and coding procedures in a timely and professional manner
• Meets assigned deadlines and provide advance warning of problems
• Works independently under the billing supervisor
• Acts as a resource within the clinic to other staff members and patients
  • Initiates physician interaction when ambiguous or conflicting information is in the medical record.
  • Exhibits knowledge and aptitude regarding coding software and resources for accurate code assignment.
  • Provides backup to other members of department as needed.
  • Other assigned duties as directed by supervisor based on demonstrated competency

Qualifications/Specifications

·      Education: High School diploma or equivalent required.

·      Licensure/Certification: Certified Professional Coder (CPC) certification required or Certification required within 12 months of hire date.

·      Experience: Minimum of one year experience in clinic or physician practice medical billing/insurance, medical records and/or coding using ICD-10 and CPT coding systems required.