Medical Physician Coder

Position Summary

Performs coding validation and review of charges for assigned medical departments to ensure timely and compliant submission of charges. Assigns, sequences, validates, and/or edits codes for assigned medical departments. Initiates, reviews, and/or edits physician queries in compliance with company policy, when appropriate.

Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to ensure coding knowledge and skills remain current.

Key Responsibilities

• Performs complex ICD-10 and CPT review and validation or ASA coding for assigned primary or medical departments.
• Establishes and maintains working relationships with Physicians to resolve specific case issues, as well as general questions and or principles.
• Participates in coding and reimbursement training programs. Provides instruction and education to staff on accurate charge entry and medical record documentation.
• Develops and maintains professional skills and up to date knowledge of regulatory and compliance issues related to coding, documentation and billing.
• Participate in professional organizations and review current literature. Stays current on all coding and reimbursement rules, regulations, trends and new developments.
• Maintains credentials and certifications for CPC on an annual basis.

Knowledge and Skills

1. Knowledge of computerized billing system required.

2. Knowledge of medical terminology, anatomy and physiology, pathophysiology, ICD-9/10-CM and CPT-4 or ASA classification systems, and regulatory agency requirements related to primary or non-surgical services.

3. Advanced knowledge of CCI, LCD and CMS PRVU, payer editing systems such as McKesson required. Preference for knowledge related to system integration.

4. Computer literacy and health care statistics computation required.

5. Excellent written and verbal communication skills to effectively deal with conflicting views and issues and mediate fair solutions.

6. Ability to work with diverse internal and external constituencies.

7. Ability to take responsibility and perform required tasks independently, as well as in a team environment.

Education

• High School / GED
• Associate’s degree

Experience

• Two years of Medical Physician coding

Skills

Anatomy, Billing, Billing Records, Certified Professional Coder (CPC), Cisco ASA (Adaptive Security Appliance), Code Reviews, Communication Skills, Computer Skills, Content Management Systems (CMS), Corporate Compliance, Corporate Policies, Current Procedural Terminology (CPT), Data Quality, Documentation, Editing, Healthcare, ICD-10, ICD-9, LCD (Liquid Crystal Display), Medical Billing, Medical Coding, Medical Records, Medical Terminology, Medical Treatment, Physiology, Presentation/Verbal Skills, Problem Solving Skills, Quality Metrics, Regulations, Regulatory Compliance, Regulatory Requirements, Reimbursement, Secondary School, Statistics, Surgical Procedures, System Integration (SI), Time Management, Training Program, Training/Teaching, Writing Skills

About the Company

Boston Children's Hospital