Certified Coder - OB/GYN

Performs functions such as reviewing documentation and selecting the appropriate procedure and / or diagnosis code to be entered in billing documents. Insures that teaching physician requirements are met and are clearly reflected in the documentation; and other duties as assigned.

EDUCATION and/or EXPERIENCE
* High school diploma or general education degree (GED) preferred
* Certified Professional Coder certification required
* Level and years of experience based on departmental needs
* Extensive knowledge of CPT and ICD-10 coding
* Knowledge of government regulations as they relate to teaching physician
documentation and billing guidelines
* Understanding of: the importance of compliance with all government, department, and contractual regulations regarding coding and billing; and provider requirements

ESSENTIAL JOB FUNCTIONS

1. Selects the appropriate procedural and diagnostic code based on provider documentation, utilizing HIPAA Standardized Code Set and applying CMS/payor guidelines.
2. Ensures that teaching physician documentation and billing requirements are met and are clearly reflected.
3. Review provider coding and provide training and feedback on coding questions and issues.
4. Assists billing and collections staff with denials and charge correction requests as needed.
5. Resolves coding TES edits.
6. Continually refreshes and applies knowledge of government regulations as they relate to coding and billing.
7. Performs internal pre-pay audits based on compliance guidelines when required.
8. Communicates with physicians about coding questions and issues.
9. Attends physician meetings to provide education on documentation / coding issues when required.
10. Follows Coder’s “Code of Ethics.”
11. Reviews reimbursement from third-party payers to ensure correct payment through proper use of codes.
12. Maintains diagnosis code master files which includes identifying inappropriate codes and informing appropriate medical staff.