Physician Coder III, Medical Records Specialist

7 days ago

Chattanooga, Tennessee, United States Erlanger Health Full time
Job Summary

The Physician Coder III plays a critical role in ensuring accurate and timely coding of physician services. As a highly skilled professional, you will be responsible for recognizing and completing a high-volume workload with minimal direct supervision. Your expertise will enable you to follow established procedures, achieve goals, and maintain professional office skills.

You will be working as a liaison between management, physician practices, and employees within the practices. Your duties will include providing CPT, HCPCS, and ICD-10-CM coding for a minimum of 1-4 specialties. These specialties may include UR, Podiatry, Plastics, Pediatrics, OB, Pain Management, Ortho, Addiction, General Surgery, Internal Medicine, Urgent Care, Pulmonary, or ED.

Facility chart types may include OT, PT, Urgent Care, ED, or other specialties. Services can include all visit types for coder I and coder II, including coding of surgical cases.

Key Responsibilities:
  • Review and analyze information available in electronic medical records and/or paper records to accurately code episodes of care in multiple specialty areas.
  • Provide various components of coding services to support providers.
  • Calculate ProFee and/or Facility E/M levels by following AMA guidelines for E/M assignment.
  • Recognize critical care cases based on patient acuity.
  • Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
  • Accurately apply diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS.
  • Interpret coding guidelines for accurate code assignment.
  • Maintain an understanding of National Correct Coding Initiatives, Local Coverage Documents, and MUEs.
  • Maintain knowledge and apply Medicare Teaching Physician Guidelines.
  • Apply knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.
  • Identify the importance of documentation on code assignment and its reimbursement impact.
  • Align conduct with AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct, supporting the Company's Ethics and Compliance Program.
  • Adhere to Det Norske Veritas (DNV) and other third-party documentation guidelines to minimize risk.
  • Continually improve coding quality and accuracy.
  • Maintain coding certification and knowledge referencing current ICD-10-CM, CPT, and/or HCPCS coding guidelines and regulatory changes.
  • Contact relevant departments or physician offices for assistance in obtaining physician clarification of diagnoses, CPT, and/or HCPCS.
  • Communicate with physicians and non-physician providers to resolve conflicting provider documentation and specify coding of diagnoses, surgeries, and procedures documented in medical records.
  • Provide ongoing feedback to physicians and other providers during charge review.
  • Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as necessary.
  • Comply with internal policies and procedures.
  • Participate in company-provided training and education.
  • Ensure individual compliance with all privacy and security rules and regulations, protecting Company confidential information, including Personal Health Information.

This position requires self-motivation, strong communication, critical thinking, and decision-making skills. You must consistently meet or exceed productivity and quality standards defined by department leadership.

Requirements
  • Knowledge of Anatomy and Physiology, Disease Pathology, and Medical Terminology.
  • Knowledge of basic coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding.
  • Able to translate written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes, CPT, and/or HCPCS to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
  • Able to navigate Electronic Medical Records to identify appropriate documentation for coding/billing in support of submitted department charges.
Education and Experience

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