The Physician Coder is responsible for accurate and timely assignment of diagnosis, procedure, and evaluation & management (E/M) codes for professional services in accordance with official coding guidelines, payer policies, and regulatory requirements. This role supports compliant billing, optimal reimbursement, and data integrity for clinical and financial reporting.
Essential Functions
Assign accurate ICD-10-CM, CPT, and HCPCS Level II codes for professional services including but not limited to:
Clinic (Family Practice, Pediatrics, GI, and Cardiology) /RHC services
Hospital-based professional services (radiology and cardiology)
Hospital and physician based surgical services (Podiatry, GI, Pain Management, Orthopedic and Ophthalmology)
Apply current AMA, CMS, NCCI, LCD/NCD, and payer-specific coding guidelines
Ensure appropriate selection of E/M levels based on documentation and medical decision-making
Review provider documentation for completeness, specificity, and compliance
Query providers when documentation is unclear, incomplete, or inconsistent with coding requirements
Validate diagnoses support medical necessity for reported services
Identify and correct coding errors prior to claim submission
Collaborate with billing, compliance, and clinical staff to resolve coding issues
Participate in denial prevention by identifying trends and education opportunities
Maintain productivity and quality benchmarks established by leadership
Stay current on coding updates, payer changes, and regulatory guidance
Support audits (internal/external) and implement corrective actions as needed
Maintain confidentiality and comply with HIPAA and organizational policies
Required Qualifications
High school diploma or equivalent
Professional coding certification :
CPC, COC, CCS, or equivalent
Minimum 2 years of professional coding experience
Strong knowledge of:
ICD-10-CM
CPT
HCPCS Level II
E/M coding guidelines
Experience with Meditech Expanse and 3M encoder
Understanding of payer reimbursement methodologies and medical necessity
Ability to interpret clinical documentation and apply coding guidelines accurately
Ability to pass a Level II background screening https://info.flclearinghouse.com
Preferred Qualifications
Experience coding Emergency Department or hospital-based professional services
Rural health or RHC coding experience
Familiarity with Medicare, Medicaid, and commercial payer policies
Audit or quality review experience
Prior experience working denials related to coding
Knowledge, Skills, and Abilities
High attention to detail and accuracy
Strong analytical and problem-solving skills
Ability to work independently and meet deadlines
Effective written and verbal communication
Professional judgment and integrity
Ability to manage multiple priorities in a fast-paced environment
Collaborative team mindset
Medical, dental, vision, STD/LTD and a 403(b) retirement plan which matches up to 6% after one year of service.
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