Certified Professional Coder

Responsible for serving as a key resource for medical coding matters. Performs reviews and audits and codes medical records to ensure the appropriate diagnostic codes and modifiers are used per Generally Accepted Medical Coding Guidelines, ICD-10 Guidelines and the CMS National Correct Coding Initiative. Participates in the implementation of the organization’s Coding Proficiency program. Interfaces and disseminates audit results to clinicians and management and provides guidance to practices on improving medical coding accuracy.

Essential Functions

  • Consistently exhibits behavior and communication skills that demonstrates Tandigm’s commitment to superior customer service, including quality, care and concern with each internal and external customer
  • Performs review of encounter notes for accuracy of ICD-10 and CPT codes prior to billing submission
  • Tasks providers regarding coding discrepancies, as needed
  • Addresses coding and documentation discrepancies prior to billing submission
  • Performs post-billing documentation audits of ICD-10 codes and documentation using Tandigm’s audit criteria
  • Assists with obtaining required visit notes for audit
  • Travels to Tandigm practices and conducts individualized training sessions with clinicians and office staff around coding and/or documentation issues based on audit results
  • Serves as a key contact with clinicians and office staff to answer coding questions
  • Works with key departments within Tandigm to review and explain documentation audit results
  • Brings questions to the ACE Medical Director as needed
  • Assists in training new Tandigm teammates
  • Supports and participates in process and quality improvement initiatives
  • Stays abreast of industry coding and compliance updates
  • Uses, protects, and discloses Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Performs additional duties as assigned

Education & Experience

  • High school diploma or equivalent required, some college a plus
  • Current/active CPC certification required with at least one (1) year of coding experience
  • Current/active CRC certification required with at least one (1) year of Risk Adjustment experience
  • ICD-10, CPT and HCPCS coding, medical terminology and regulatory requirements with two (2) years medical chart auditing experience a plus
  • Prior healthcare work experience related to Coding, Medical Billing and Risk Adjustment preferred

Knowledge, Skills, Abilities

  • Demonstrated knowledge of ICD-10, HCPCS and CPT coding guidelines, medical terminology, anatomy and physiology
  • Demonstrated analytical and problem-solving ability regarding barriers to receiving and validating accurate chart documentation information
  • Accurate and precise attention to detail
  • Ability to travel throughout the five county Philadelphia region as needed (Philadelphia, Chester, Delaware, Bucks, and Montgomery counties)
  • Strong computer skills in data entry, coding, and knowledge of Electronic Medical Record softwareOpens a New Window.
  • Proficient in Microsoft Word and Excel
  • Knowledge of CMS coding guidelines
  • Excellent verbal and written communication skills in the English language
  • Must be able to work independently and as a team
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