Job Description
Job Summary The Physician Coder is responsible for reviewing, analyzing, and assigning accurate CPT, HCPCS, and ICD-10 codes for professional fee services documented in the medical record. This role ensures proper sequencing, modifier use, and place-of-service coding in compliance with governmental regulations, third-party payer policies, and corporate standards. The Physician Coder plays a key role in revenue cycle accuracy by identifying documentation gaps, ensuring coding integrity, and working collaboratively with internal teams to support physician coding compliance and reimbursement. Essential Functions Assigns accurate CPT, HCPCS, and ICD-10 codes for professional services, procedures, diagnoses, and treatments based on provider documentation. Ensures compliance with governmental regulations, third-party payer policies, and corporate coding protocols, following National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs). Performs coding audits and quality reviews, verifying accuracy of documentation and identifying areas for provider education. Works coding-related claim edits, holds, and scrubs in the electronic billing system (e.g., Athena Collector), ensuring timely claim resolution and reimbursement. Collaborates with physicians, revenue cycle teams, and coding education staff, requesting clarification when necessary to ensure optimal documentation and compliance. Performs edit checks on coded data before transmittal, identifying and correcting errors as needed. Maintains strict confidentiality of patient records, provider information, and financial data, adhering to HIPAA and corporate compliance policies. Escalates documentation or coding issues to the coding education team for provider training and improved documentation practices. Assists in coding-related special projects, ensuring accurate reporting and analysis of coding data for operational improvement. Performs other duties as
