Planned Parenthood of Metropolitan New Jersey

Medical Billing and Coding

• Reporting to the Director of Revenue Cycle, the Medical Coder translates clinical documentation into standardized codes for billing, reporting, and quality initiatives.
• Supports coding audits, revenue cycle workflows, and regulatory compliance.
• Verifies clinical information with medical staff, resolving documentation gaps, and collaborating with billing staff to ensure accurate claims submission.
• Ensures appropriate codes are assigned to all procedures and diagnoses.
• Assigns and sequences of ICD-10-CM, CPT & HCPCS codes accurately in compliance with government and insurance regulations.
• Ensures codes reflect patient diagnoses and procedures as documented by clinicians, meeting payer, OSHA, and HIPAA requirements.
• Reviews and abstracts clinical documentation from outpatient encounters to assign accurate ICD-10-CM, CPT/HCPCS codes, and modifiers.
• Clarifies and resolves coding questions or ambiguities for staff as needed.
• Gathers and compiles data from clinicians, EPIC, and other sources for monthly reporting.
• Collaborates with the Director of RQM to investigate reported medical malpractice by analyzing and identifying the medical procedures, diagnoses, or events that contributed to negligence.
• Validates coding accuracy through prospective and retrospective coding audits; implements corrective actions as needed.
• Collaborates with lead clinicians, clinicians, and other team members to resolve documentation gaps that affect coding accuracy and reimbursement.
• Maintains up-to-date knowledge of payer policies, CMS/Medicare updates, and specialty-specific coding practices (e.g., family practice, women’s health, etc.).
• Submits coded data to billing and medical records systems; verifies proper claim submission to ensure optimal reimbursement