Medical Billing and Coding

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – Cardiology

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines
• Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – ENT, Audiology

• Lead hospital and professional coding operations to ensure accuracy, timeliness, and compliance
• Monitor coding volumes, turnaround times, productivity, quality, and regulatory adherence
• Translate organizational strategy into departmental goals, action plans, and performance metrics
• Foster strong collaboration between Coding and Clinical Documentation Improvement (CDI) teams
• Develop and implement coding and documentation improvement policies and procedures
• Partner across the organization with physicians, administrators, IT, revenue cycle teams, and vendors
• Manage departmental operating budgets and resources
• Hire, train, coach, and evaluate coding staff; support performance improvement and development
• Oversee both in-house and vendor-supported coding teams to meet productivity and quality standards
• Ensure compliance with federal regulations, payer guidelines, and organizational policies
• Generate, analyze, and act on coding productivity and quality reports
• Conduct audits, provide education, and implement corrective actions as needed
• Stay current with ICD-10-CM/PCS, CPT, HCPCS, and regulatory changes
• Recommend and implement process improvements and automation tools

Medical Coding Manager – HB, PB

• Review and analyze professional medical records, including office visits, hospital-based professional services, and outpatient encounters
• Assign accurate ICD-10-CM, CPT, and HCPCS codes
• Apply appropriate CPT modifiers, units, place of service indicators, and payer-specific billing rules
• Abstract and enter coded data into Epic and other professional billing and coding systems
• Ensure compliance with official coding guidelines, regulatory requirements, payer policies, and organizational standards
• Maintain a minimum coding accuracy rate of 95% and meet established productivity benchmarks
• Review, investigate, and resolve claim edits and coding-related errors
• Validate provider documentation and query providers for clarification or additional detail when needed
• Serve as a subject matter expert for professional coding, including E/M services, procedure coding, and modifier usage
• Collaborate with providers, clinical staff, educators, and revenue cycle teams to resolve coding and documentation issues
• Monitor and communicate coding and documentation trends impacting professional billing and compliance
• Stay current on coding updates, regulatory changes, and professional billing requirements
• Participate in audits, education, training, and continuous improvement initiatives
• Perform other duties as assigned

Certified Medical Coding Specialist – Professional Based

• Review and analyze Emergency Department clinical documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes for professional and facility components
• Assign appropriate ED Evaluation & Management (E/M) levels using current medical decision-making and/or time-based guidelines
• Code ED procedures, including injections, infusions, laceration repairs, splinting, and other emergency services
• Apply modifiers, units, NCCI edits, and payer-specific billing rules to ensure compliant charge capture
• Validate documentation completeness and initiate provider queries when clarification is required
• Serve as a subject matter expert in ED-specific coding and reimbursement methodologies
• Collaborate with providers, clinical teams, CDI, and revenue cycle partners to resolve coding and documentation issues
• Abstract and enter coded data into Epic and other coding/billing systems within established turnaround times
• Monitor trends in documentation quality, coding accuracy, and denials; communicate findings to leadership
• Maintain productivity and quality benchmarks within ED single-path workflows
• Stay current on regulatory updates, coding guideline changes, and payer requirements

Certified Medical Coding Specialist – Emergency Department

• Supervise daily operations of the professional (physician) coding team to ensure accurate, compliant coding and achievement of quality and productivity benchmarks
• Monitor, work, and reconcile professional coding and claim edit work queues daily to ensure workflows are current, balanced, and accurate
• Provide daily workflow management, including workload distribution and staff allocation to meet operational goals and service-level expectations
• Collaborate with Outpatient Physician Coding Educator, Director of Revenue Integrity, physician leadership, practice managers, CDI, compliance, and revenue cycle partners to ensure complete documentation and accurate CPT, ICD‑10‑CM, and modifier assignment
• Support denial prevention and resolution efforts by reviewing coding-related rejections and denials, identifying trends, and recommending corrective actions
• Create and manage coder work schedules, attendance, and assignments to ensure appropriate coverage and continuity of operations
• Facilitate onboarding of newly hired certified professional coders, including training, mentoring, skills assessments, coaching, and performance evaluations
• Provide ongoing education and development for professional coding staff related to payer policies, regulatory changes, and best practices
• Partner with EHR and IT optimization teams to remain current on system enhancements, template changes, and workflow updates impacting professional coding
• Coordinate education related to CPT, ICD‑10‑CM, HCPCS, modifier usage, and annual code set updates, including oversight of coding reference materials
• Assist in the development, implementation, and maintenance of professional coding policies, procedures, and documentation standards
• Communicate, escalate, and track provider coding and documentation issues to HIM/Coding and revenue cycle leadership as appropriate
• Perform other duties as assigned

Medical Coding Supervisor

• Review and analyze inpatient and outpatient medical records to assign accurate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes, as applicable
• Ensure coding compliance with official guidelines, payer-specific requirements, and organizational policies
• Apply knowledge of APC and DRG assignment and understand the impact on reimbursement
• Validate clinical documentation and query providers when clarification is required
• Collaborate with Clinical Documentation Improvement, providers, and revenue cycle teams to resolve coding-related issues
• Abstract and enter coded data into Epic and other coding systems
• Maintain established productivity and accuracy standards
• Participate in coding audits, quality initiatives, and continuous improvement efforts
• Stay current with coding updates, regulatory changes, and payer policy requirements
• Protect patient confidentiality and comply with HIPAA regulations

Certified Medical Coder, Inpatient and Outpatient

• Responsible for assisting the coding department with the day-to-day non-coding duties support activities
• Assigns codes to office-based visits and procedures using the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS)
• Resolve coding edits to assure accurate and complete claims submission
• Sequences diagnoses and procedure codes as outlined in CPT, ICD-10-CM, and HCPCS Coding Guidelines while adhering to local and national governmental payer guidelines
• Reviews all clinician documentation to support assigned codes in the health information record
• Follows up and obtains clarification of inaccurate documentation as appropriate
• Codes risk adjustable encounters, resolves CRMs, and trends coding denials, as assigned
• Conducts formal coding and documentation reviews, clinician reviews and quality reviews, as assigned
• Assists with coding research functions and education activities
• Creates clinician coding and documentation education based on query trends or ad-hoc requests
• Adheres to the organization and departmental guidelines, policies, and protocols.
• Abides by Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement
• Maintains confidentiality of patient.

Physician Support Coder

• Evaluate medical records and provide clinical and surgical abstraction
• Accurately code diagnostic and procedural information
• Consult with medical providers for record clarification
• Ensure compliance with coding rules and regulations
• Compile reports and tabulate data from medical records
• Identify validation edits and ensure accurate coding
• Work independently under regular supervision

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