Senior Physician Coder
Job Code: 29390
Position Summary
The Senior Physician Coder serves as the advanced technical resource for professional services (physician/clinic) coding, ensuring accurate, compliant coding and complete charge capture across multiple specialties and payers. This role codes complex encounters, audits coded charges, and provides education to coders, clinic providers, and staff. This role partners with Billing, AR, Revenue Integrity, and Hospital Coding to reduce denials and support appropriate reimbursement.
Responsibilities
- Reviews, interprets, and codes complex professional services encounters across multiple specialties, applying coding regulatory requirements and multiple payer guidelines
- Ensures full, compliant coding and charge capture for reimbursement, billing, and denial analysis
- Audits coded encounters and charges, tracks errors and trends, and provides real-time feedback and education to coders, clinic providers, and staff
- Serves as a technical resource and subject matter expert for coding staff, resolving complex coding questions and assisting with training, onboarding, and the development of training materials
- Analyzes denials, productivity, and other coding performance data, conducts root cause analysis, and recommends and helps implement corrective actions
- Collaborates with clinic providers, clinic staff, Billing, AR, Revenue Integrity, and Hospital Coding to resolve coding and charge capture issues and increase efficiencies and revenue related to coding
- Monitors regulatory and payer guideline updates and helps develop and update coding policies, processes, and procedures to ensure compliance
- Meets or exceeds established productivity and quality standards, and covers coding and auditor/trainer areas as necessary
- Exercises discretion to establish new coding compliance policies or organizational standards
- Relies on experience and judgment to plan and accomplish goals
- Regular and predictable attendance is an essential job function
- Performs other related duties as assigned
- Competent to meet age-specific needs of the unit assigned
Requirements and Minimum Qualifications
- Associate’s degree in health information management or related field; 2 years of related experience may be accepted in lieu of degree
- Minimum 2 years’ coding auditing experience preferred
- Minimum 5 years’ professional services (physician/clinic) coding experience for various specialties
- Experience preparing and delivering training materials to individuals and staff groups preferred
- Advanced knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and E/M guidelines across multiple specialties
- Knowledge of CMS and multiple payer coding, billing, and charge capture requirements
- Previous Epic experience required
- Strong knowledge of anatomy, physiology, medical terminology, and disease processes
- Ability to analyze data and conduct root cause analysis of denials
- Excel experience preferred
- Ability to develop and deliver education to coding staff, clinic providers, and clinic staff
- Effective communication skills for serving as a liaison with clinic providers, staff, and revenue cycle teams
Working Conditions
- Must be able to maintain a sitting position
- Typical equipment used in an office job
- Repetitive movements
