Job Summary
The Certified Coder III is responsible for advanced, accurate, and compliant coding of outpatient gastroenterology clinic services. Reviews clinical documentation, assigns and validates appropriate ICD-10-CM, CPT, and HCPCS Level II codes and modifiers, resolves coding edits and documentation deficiencies, and supports timely, accurate claims submission. Serves as a coding resource for providers, clinic personnel, and revenue cycle partners; performs targeted quality reviews and assists with education and workflow improvement. This position supports the Gastroenterology Clinic only and does not assume responsibility for coding services performed at the Ambulatory Surgery Center unless separately authorized through a change in assignment.
Performance Expectations
Outpatient Gastroenterology Coding
Accurately code new and established patient office visits, consultations when payable, and other clinic services using current official coding guidance and payer requirements.
Apply E/M coding guidelines, including medical decision-making or time as supported by documentation; evaluate appropriate modifiers and separately reportable services.
Code clinic-based diagnostic services, including abdominal ultrasound and transient elastography (FibroScan), only when furnished, documented, and reportable under applicable requirements.
Validate diagnosis specificity, medical necessity, diagnosis-to-procedure linkage, and coding sequence without adding unsupported diagnoses or services.
Distinguish clinic professional and facility billing rules as applicable; route ASC procedure coding issues to the responsible ASC coding team.
Documentation Integrity and Compliance
Review provider notes, orders, test reports, and supporting documentation for completeness and coding support; initiate compliant, nonleading clarification queries when necessary.
Apply current ICD-10-CM, CPT, HCPCS, NCCI edits, Medicare policies, and payer-specific guidance; identify bundling, modifier, and coverage concerns.
Protect patient information, comply with HIPAA, organizational compliance policies, and applicable record retention requirements.
Identify and escalate suspected upcoding, unbundling, unsupported billing, or other compliance concerns through approved channels.
Revenue Cycle and Quality
Work assigned coding queues and edits promptly; investigate coding-related denials, correct validated errors, and document resolutions.
Partner with billing, patient access, authorizations, and clinical staff to address coding issues while preserving distinct departmental responsibilities.
Perform focused coding accuracy audits, analyze recurring trends, and recommend corrective actions and education.
Monitor changes to codes, guidelines, and payer policies; communicate material changes to affected stakeholders.
Collaboration and Professional Practice
Serve as an advanced coding resource and mentor to other coders as assigned; assist with orientation and competency development.
Provide objective provider feedback regarding documentation specificity, E/M selection, and coding requirements without directing clinical decision-making.
Maintain productivity, accuracy, professionalism, confidentiality, and timely communication consistent with Forrest Health expectations.
Perform other reasonably related duties as assigned within the approved role and scope.
Qualifications
Education: High school diploma or equivalent required; postsecondary coursework in health information management, medical coding, or a related field preferred.
Certification: Current nationally recognized professional coding credential required; CPC (AAPC), CCS-P (AHIMA), or comparable outpatient/professional coding credential preferred. Final accepted credentials subject to Revenue Cycle approval.
Experience: Proposed: at least three years of progressively responsible outpatient or professional-fee coding experience, including advanced E/M coding. Gastroenterology specialty experience strongly preferred.
Knowledge and skills: Advanced knowledge of ICD-10-CM, CPT, HCPCS, modifiers, E/M coding, payer edits, medical terminology, anatomy and physiology, and coding compliance. Proficiency with Epic or comparable EHR, coding workqueues, and encoder/edit tools preferred.
Continuing education: Maintain required credential status and continuing education; demonstrate competency with annual coding updates.