The Certified Professional Coder (CPC) uses knowledge, training and experience 1) to apply the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis, and claims processing; 2) query physicians when code assignments or documentation in the record does not appear to be adequate, in ambiguous, or unclear for coding purposes. The Certified Professional Coder has an affirmative obligation to keep abreast of current coding guidelines and reimbursement reporting requirements.

Principal Duties and Responsibilities:

1. Oversees and monitors implementation of the Health Information Management (HIM) compliance program;
2. Develops and coordinates educational and training programs regarding elements of the HIM compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including Him coding staff, physicians, billing personnel, and ancillary departments;
3. Conducts monthly audits and coordinates ongoing monitoring of coding accuracy and documentation adequacy. Provides written reports of findings to Compliance Department, Quality Management Committee, and the Finance Department;
4. Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians;
5. Reviews claim denials and rejections pertaining to coding and medical necessity issues upon written approval and implements corrective action plan, such as educational programs, to prevent similar denials and rejections from recurring;
6. Conducts internal investigations of changes in coding practices or reports of other potential problems pertaining to coding to supervisor, bi-monthly;
7. Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity;
8. Reports noncompliance issues detected through auditing and monitoring, nature of corrective action plans implemented in response to identified problems, and results of follow-up audits to the Compliance Department;
9. Undertakes actions needed to maintain current knowledge of applicable coding and reporting requirements;
10. Reviews and makes recommendations to formulate appropriate policies to guide billing of professional fees;
11. Assists with reporting of high-risk compliance issues, investigations, as warranted, and necessary corrective action plans as assigned;
12. Maintains confidentiality of patients and corporate information.

Qualifications:

1. Minimum of successful completion of a coding certificate program approved by the American Health Information Management Association (AHIMA) or the AAPC.
2. Five years of outpatient medical coding experience preferred.
3. Must have basic computer skills.
4. Experience as a medical coder or strong training background in medial coding reimbursement preferred.
5. Extensive knowledge of healthcare reimbursement systems.
6. Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to medical documentation, coding, and billing.
7. Maintain current certification status.