Responsible for accurately reviewing and assigning Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and ICD-10-CM codes for professional claims billed by Capital Health Medical Group (CHMG) for hospital and outpatient procedures
Accurately applies official coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) for assignment of procedural and diagnostic codes
Reviews procedure documentation for accurate assignment of ICD-10-CM diagnosis, current procedural terminology (CPT-4) codes and modifiers
Ensures appropriate coding of evaluation and management services when applicable
Meets or exceeds departmental accuracy and productivity standards
Ensures compliance with national coding guidelines and Capital Health's policies for complete, accurate and consistent coding resulting in appropriate reimbursement and data integrity
Fosters teamwork and collaboration
Addresses professional coding pre-bill edits timely to ensure minimal days in DNFB
Acts as a subject matter expert for professional coding

Candidates must reside in the New Jersey/Pennsylvania area
High school diploma or equivalent
Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC), or Certified Coding Specialist-Physician (CCS-P) certification required
Associate's degree in health information management preferred
Two years' experience in physician coding role preferred
ICD-10-CM, CPT-4 and HCPCS coding experience preferred
One year surgical coding experience preferred
Knowledge and Skills: Excellent verbal and written communication skills
Strong knowledge of surgical coding guidelines
Knowledge of pathophysiology and disease processes
Special Training: Physician coding and training certification
Proficient with Microsoft applications to include Outlook, Word, Excel, PowerPoint
Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge
CPC-A, CPC, or CCS-P required

Professional Coder

Key skills