PB Coder

The PB Coder is responsible for reviewing, analyzing, and accurately coding ambulatory and/or hospital-based encounters. This role performs initial charge review for E/M visits, diagnostic tests, and procedures across multiple specialty departments to determine the appropriate assignment of CPT, ICD-10, HCPCS codes, and modifiers for reporting physician services to third-party payers. The PB Coder ensures all coding aligns with established coding standards, regulatory requirements, and reimbursement policies.

Essential Duties and Responsibilities:

Analyzes provider documentation to assure appropriate Evaluation Management (E/M) levels are assigned using the correct CPT and current Evaluation and Management Guidelines

Analyzes provider documentation to assure that appropriate CPT codes are assigned for surgeries and other diagnostic procedures. Ensures that all coding aligns with coding standards, regulatory requirements and other reimbursement policies such as surgical global package

Interprets outpatient office visit notes/hospital patient encounters and charge documents to determine services provided and accurately assign CPT, Modifiers, and ICD-10 DX coding to these services

Performs comprehensive review of all types of encounters to assure all vital information such as patient identification, signatures, attestation, and dates are present in the record. Evaluate documentation for consistency and adequacy. Ensure diagnosis accurately reflects the care and treatment rendered

Monitors and follows up to ensure all services billed are captured and coded with their assigned coding responsibilities

Follows and adheres to all WWT policies such as Coding Audit Policy and Physician Coding Query In-Basket Policy

Provide real time feedback to providers on all coding changes and trends via EPIC in basket message

Regularly participate and engage all coding meetings and other ad-hoc meetings as needed. Works in coordination with other members of the physician’s office/departments as necessary

Collaborates with Coding Management Team for special coding and billing projects if assigned

Resolving coding denials assigned by applying coding knowledge and skills. Apply coding knowledge and skills to resolve coding denials from payers and works with management and various departments

Maintains active coding credentials and CEU’s required for coding roles

Performs other related duties as required and assigned

Knowledge, Skills Abilities

Knowledge and understanding of medical coding and billing systems and regulatory requirements

Communication - communicates clearly and concisely, verbally and in writing

Persistence – comfortable pursuing, rebutting and escalating issues as appropriate

Goal-oriented – holds him/herself accountable to achieving shared professional and personal goals.

Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

Interpersonal skills – establishing and maintaining effective working relationships with employees, and external parties.

PC skills - demonstrates high proficiency in Microsoft Office applications, especially Microsoft Excel, and others as required

Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately

Education/Experience :

Certified professional coder CCS-P, CPC, RHIT or RHIA through AAPC or AHIMA with a minimum of two years’ experience with CPT/ICD-10 coding of multispecialty services preferred. Responsible for maintaining continuing education per certification requirements

Clear understanding of protocols and procedures in a medical office including health information management, confidentiality, and safety

Organize and prioritize responsibilities while remaining flexible to changing demands

Excellent written and oral communication skills, with the ability to interact with patients, families, staff and others.

Strong analytical skills and attention to detail

Ability to establish priorities and work independently

Must have high level of discretion and judgment