REMOTE PROFESSIONAL CERTIFIED CODER

The Remote Professional Certified Coder is responsible for accurately coding and abstracting office, observation, inpatient, and general surgical records, including complex ambulatory and inpatient procedures across one or more specialized procedural areas. The Coder ensures complete and compliant coding of provider accounts to meet reimbursement and reporting requirements, collaborating with various departments to resolve errors and verify medical necessity and demonstrates flexibility with assignments within professional scope/duties/licensure. This position requires independent work in a fast-paced environment, with the ability to prioritize tasks as needed. The Coder must maintain a customer-focused, professional attitude and contribute to all necessary job duties within the scope of their position

Essential Duties

Accurate Coding & Abstraction:

• Code and abstract office, observation, inpatient records, and surgical procedures (expertise in one or more procedural areas such as Cardiology, Neurosurgery, General Surgery, Plastics, or Podiatry).
• Assign and sequence appropriate ICD-10-CM codes for all diagnoses, signs, symptoms, and conditions documented in the medical record.
• Accurately assign CPT/HCPCS codes for procedures performed and services rendered, ensuring codes correspond with diagnosis codes.
• Add necessary modifiers to CPT codes to ensure full description of services provided.

Compliance and Error Reconciliation:

• Review and respond to APC, OCE, CCI, and medical necessity edits identified during coding sessions, ensuring compliant coding and optimal reimbursement.
• Assist with end-of-month and error reconciliation processes, including the retrospective verification of medical necessity and error resolution.
• Collaborate with Patient Financial Services, source departments, and providers to ensure timely and error-free coding and billing.

Billing and Documentation Requirements:

• Apply recognized coding guidelines and billing requirements for Medicare, Medicaid, HMO, PPO, and other payors, adhering to state and federal law.
• Understand and ensure compliance with HCC (Hierarchical Condition Category) risk-adjustment documentation requirements and coding rules.

Education and Professional Development:

• Participate in continuing education to stay current with coding updates, regulations, and to maintain professional certification.
• Collaborate with the coding team to stay updated on regulatory changes, coding trends, and industry best practices.

Non-essential Duties

• Assist with special projects and tasks as needed to meet team goals and deadlines.
• Actively engage in professional development and contribute to team discussions on coding compliance.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so your journey at and away from work is remarkable.  Our Total Rewards package includes:

Compensation

• Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift differential, on-call
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Required Experience

• Minimum of 3 years of current coding experience in a proceduralist office setting or ambulatory surgery center, specializing in at least one procedural area (e.g., Cardiology, Neurosurgery, General Surgery, Plastics, or Podiatry) required.

Preferred Experience

• Strong understanding of official coding guidelines, medical terminology, human anatomy, and disease processes.
• Proficiency in HCC/risk-adjustment coding.
• Excellent attention to detail, problem-solving abilities, and critical thinking skills.
• Proficient in Microsoft Office applications and virtual presentation software
• Two to three years of experience in physician billing preferred.

Required Licensure/Education

• High school diploma or equivalent required
• AAPC/CPC (Certified Professional Coder) certification.
• Expertise in ICD-10-CM and CPT/HCPCS coding principles.

Preferred Education

• Associate degree in a health-related field preferred.
• Advanced certifications in coding (such as AAPC/CRC or CPMA) are highly desirable.
• Expertise in ICD-10-CM, CPT/HCPCS coding principles, including familiarity with 2021/2023 outpatient and inpatient E/M guidelines.

Employee Health Requirements

Exposure to:

• Chemicals: Printer, copier, and fax toners; liquid paper
• Video Display Terminals: Extreme
• Blood and Body Fluids: None
• TB or Airborne Pathogens: None other than normal hospital environment exposure.

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Telephone and in person communication with customers, physicians, staff, and peers.
• Vision: View computer screen, medical records, reports; access and review hard copy & online references & resources; file and retrieve records; identify and copy requested documents; prepare and distribute reports
• Smell: N/A
• Hearing: Telephone and in person communication with customers, physicians, staff, and peers; hear and respond to telephone, overhead pages, and emergency announcements; participate in inservice and continuing education programs
• Touch: Write, keyboard; file/retrieve documents, reports and records; photocopy; prepare and distribute reports & records

Activity/Lifting Requirements

Percentage of time during the normal workday the employee is required to:

• Sit: 88%
• Twist: 0%
• Stand: 2%
• Crawl: 0%
• Walk: 3%
• Kneel: 1%
• Lift: 2%
• Drive: 0%
• Squat: 1%
• Climb: 1%
• Bend: 1%
• Reach above shoulders: 1%

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently
• Up to 20 lbs: Frequently
• Up to 35 lbs: Occasionally
• Up to 50 lbs: Not Required
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required
• Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):

Stacks of charts, supplies carried waist high approximately 300 ft. May have to carry records up/down circular staircase. Carrying/lifting/bending with charts to file or retrieve in various department locations. Carrying paper/file folders through department. Reams of paper to printers/photocopier

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 240
• Twist: 0
• Stand: 10
• Crawl: 0
• Walk: 2
• Kneel: 0
• Lift: 2
• Drive: 0
• Squat: 1
• Climb: 1
• Bend: 1
• Reach above shoulders: 2

Repetitive use of hands (Frequency indicated):

• Simple grasp up to 10 lbs. Normal weight: 5-10lbs frequent
• Pushing & pulling Normal weight: <50lbs rare>
• Fine Manipulation: Writing instruments, clips, fasteners, stapler & staple remover; keyboarding, filing/retrieval, copying, folder creation, record review, sorting, accessing reference materials.

Repetitive use of foot or feet in operating machine control: None

Environmental Factors & Special Hazards

• Environmental Factors (Time Spent):
• Inside hours: 8
• Outside hours : 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Normal Range
• Atmosphere: Dust
• Special Hazards:
• Protective Clothing Required: None